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General NPI Number Information
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NPI Number | 1194007500
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Entity Type | Individual
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Provider Name | KARL DOUGLAS FREITAG MA LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 2435 KIMBERLY RD. STE #155
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City | BETTENDORF
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State | IA
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Zip | 52722
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Country | US
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Telephone | 563-359-7625
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Fax | 563-459-0494
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Provider Business Mailing Address
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Address Line | 2435 KIMBERLY RD. STE #155
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City | BETTENDORF
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State | IA
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Zip | 52722
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Country | US
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Telephone | 563-359-7625
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Fax | 563-459-0494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 01604
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License Number State | IA
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