Healthcare Provider Details

I. General information

NPI: 1659712701
Provider Name (Legal Business Name): KATHLEEN C FREET MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 ILLINOIS ST
PLYMOUTH IN
46563-3622
US

IV. Provider business mailing address

2621 E JEFFERSON ST
WARSAW IN
46580-3880
US

V. Phone/Fax

Practice location:
  • Phone: 574-936-9646
  • Fax: 574-935-4773
Mailing address:
  • Phone: 574-269-0573
  • Fax: 574-269-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007373A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: