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General NPI Number Information
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NPI Number | 1447301908
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Entity Type | Individual
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Provider Name | MARY G FREITAG PSYD LP
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 10480 PERKINS AVE N
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City | STILLWATER
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State | MN
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Zip | 55082-9273
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Country | US
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Telephone | 651-357-3216
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Fax | 651-730-6657
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Provider Business Mailing Address
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Address Line | 10480 PERKINS AVE N
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City | STILLWATER
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State | MN
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Zip | 55082-9273
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Country | US
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Telephone | 651-357-3216
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Fax | 651-730-6657
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4319
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License Number State | MN
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