Healthcare Provider Details

I. General information

NPI: 1477598696
Provider Name (Legal Business Name): CHERYL ANN FREGOLLE MSW/LMSW, CAC-1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 EUREKA RD SUITE 819
TAYLOR MI
48180-5343
US

IV. Provider business mailing address

20600 EUREKA RD SUITE 819
TAYLOR MI
48180-5343
US

V. Phone/Fax

Practice location:
  • Phone: 734-285-8282
  • Fax: 734-281-0402
Mailing address:
  • Phone: 734-285-8282
  • Fax: 734-281-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: