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General NPI Number Information
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NPI Number | 1932887619
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Entity Type | Individual
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Provider Name | JACLYNN MARY FRIESEN
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 6131 NESBITT RD STE 200
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City | FITCHBURG
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State | WI
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Zip | 53719-1891
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Country | US
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Telephone | 608-203-6267
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 OKEEFFE AVE APT 220
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-4235
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Country | US
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Telephone | 507-210-7716
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1054-228
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License Number State | WI
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