Provider Demographics
NPI:1588727770
Name:FREEMAN, KYLE FREDRIK (LCSW)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:FREDRIK
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20942 SPINNAKER ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8428
Mailing Address - Country:US
Mailing Address - Phone:541-640-1160
Mailing Address - Fax:
Practice Address - Street 1:20942 SPINNAKER ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8428
Practice Address - Country:US
Practice Address - Phone:541-640-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL60111041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHB994AOtherMEDICARE