Provider Demographics
NPI:1841724606
Name:FREIVOGEL, LINDSEY (MS ABA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:FREIVOGEL
Suffix:
Gender:F
Credentials:MS ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3873 BOTANICAL AVE APT F
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-4086
Mailing Address - Country:US
Mailing Address - Phone:618-698-3073
Mailing Address - Fax:
Practice Address - Street 1:2560 METRO BLVD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2417
Practice Address - Country:US
Practice Address - Phone:314-715-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017004345103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst