Healthcare Provider Details

I. General information

NPI: 1821179011
Provider Name (Legal Business Name): JOELENE THERESE FRIESTAD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703
US

IV. Provider business mailing address

1654 BRIGANTINE LANE
ORANGE CA
92867
US

V. Phone/Fax

Practice location:
  • Phone: 562-467-0209
  • Fax:
Mailing address:
  • Phone: 714-974-9842
  • Fax: 562-924-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 9944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: