Healthcare Provider Details

I. General information

NPI: 1417473133
Provider Name (Legal Business Name): STEPHANIE L FRIESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N OLIVER ST
WICHITA KS
67220-2106
US

IV. Provider business mailing address

3223 N OLIVER ST
WICHITA KS
67220-2106
US

V. Phone/Fax

Practice location:
  • Phone: 316-558-3410
  • Fax: 316-267-5444
Mailing address:
  • Phone: 316-558-3410
  • Fax: 316-267-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: