Healthcare Provider Details

I. General information

NPI: 1497299309
Provider Name (Legal Business Name): JACQUELINE FRITTS PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE CHRISTIE PSYD, LP

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 S LOWER HAY LAKE RD
SAULT SAINTE MARIE MI
49783-8600
US

IV. Provider business mailing address

11133 S LOWER HAY LAKE RD
SAULT SAINTE MARIE MI
49783-8600
US

V. Phone/Fax

Practice location:
  • Phone: 210-287-0622
  • Fax:
Mailing address:
  • Phone: 210-287-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019339
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: