Fridel, Keith Wayne

Fridel, Keith Wayne is an individual health care provider with primary practice located at 1415 Saint Francis Ave , Shakopee MN 55379-3374. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Fridel, Keith Wayne can be contacted via phone (952) 993-7750.

Contact Information

Primary practice address
1415 Saint Francis Ave Shakopee MN 55379-3374
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 071008852 Illinois

Profile Details

NPI number 1215345244
LBN Legal business name Fridel, Keith Wayne
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2014
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215345244 NPPES
Illinois Other 071008852 STATE LICENSE

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