MEDICARE: DANIELLE FRIEDER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY11741	FL
2	103TC0700X	Clinical Psychologist	071.010321	IL

General Provider Information

NPI Number	:	1184283756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE FRIEDER PSYD

Provider Business Mailing Address
First Line	:	PO BOX 295
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-0295
Country	:	US
Telephone Number	:	312-481-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	3665 WOODHEAD DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1816
Country	:	US
Telephone Number	:	312-481-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	03/04/2026

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