Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301014080 | MI |
Y | 103T00000X | Psychologist | 6301014080 | MI |
N | 102L00000X | Psychologist | 840 | WV |
N | 103T00000X | Psychologist | 840 | WV |
N | 103TH0004X | Health Psychologist | 6301014080 | MI |
N | 103TH0004X | Health Psychologist | 840 | WV |
NPI | 1417380007 |
---|---|
Provider Name | Shannon Froese |
First Address | Saginaw, MI 48604-2818 |
Second Address | Saginaw, MI 48604-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2013 |
Last Update Date | 19/08/2013 |