Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1386073724 |
---|---|
Provider Name | Danielle Freund |
First Address | Bloomington, IL 61701-2814 |
Second Address | Bloomington, IL 61701-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2013 |
Last Update Date | 06/11/2013 |