Healthcare Provider Details

I. General information

NPI: 1033074455
Provider Name (Legal Business Name): LENDRA MAXINE FRIESEN MS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BLOOMFIELD AVE STE 400
WINDSOR CT
06095-2700
US

IV. Provider business mailing address

34 LEDGE DR
ROCKY HILL CT
06067-3513
US

V. Phone/Fax

Practice location:
  • Phone: 860-690-5448
  • Fax:
Mailing address:
  • Phone: 860-690-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23849454
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: