=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992685408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANGING TIDES COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5303 E JELINEK AVE STE A
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54476-4230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-551-8257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1217 PASHA AVE
-----------------------------------------------------
City | MOSINEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54455-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAELEE FREUDIGMANN
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 715-551-8257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------