MEDICARE: KATIE FREEMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1974-C	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5A356	OTHER	AR	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1982738456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE FREEMAN LCSW

Provider Business Mailing Address
First Line	:	221 N EAST AVE STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5226
Country	:	US
Telephone Number	:	479-957-0189
Fax Number	:	479-431-2548

Provider Business Practice Location Address
First Line	:	221 N EAST AVE STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-5226
Country	:	US
Telephone Number	:	479-957-0189
Fax Number	:	479-431-2548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	04/04/2023

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Directions to “ KATIE FREEMAN LCSW” Practice Location

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