Individual
DR. KEITH WAYNE FRIDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1415 SAINT FRANCIS AVE, SHAKOPEE, MN 55379-3374
(952) 993-7750
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071008852
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071008852
STATE LICENSE
IL
Enumeration date
07/22/2014
Last updated
03/17/2018
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