Provider Demographics
NPI:1962106047
Name:FRAIDENBURG, LILLIAN MARIE
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARIE
Last Name:FRAIDENBURG
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 1:332 PLYMOUTH ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4938
Mailing Address - Country:US
Mailing Address - Phone:563-212-9145
Mailing Address - Fax:
Practice Address - Street 1:4606 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4146
Practice Address - Country:US
Practice Address - Phone:253-693-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician