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
Phone: (952) 993-7750
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215345244 | NPPES |
| Illinois | Other | 071008852 | STATE LICENSE |
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