Provider Demographics
NPI:1891531521
Name:LAFRENIERE, TEDRA
Entity type:Individual
Prefix:
First Name:TEDRA
Middle Name:
Last Name:LAFRENIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 W 43RD PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4088
Mailing Address - Country:US
Mailing Address - Phone:509-222-8609
Mailing Address - Fax:
Practice Address - Street 1:1919 N PITTSBURG ST STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7216
Practice Address - Country:US
Practice Address - Phone:509-233-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician