Individual
TARA FREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RSA
Contact information
Practice address
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1059
(618) 939-4444
Mailing address
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1059
(618) 939-4444
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37711
IL
171M00000X
Case Manager/Care Coordinator
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Other
Enumeration date
03/26/2021
Last updated
12/30/2025
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