Individual
DAVID FRIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
671 S LEWIS AVE, WAUKEGAN, IL 60085-6101
(847) 782-4130
(847) 782-1030
Mailing address
671 S LEWIS AVE, WAUKEGAN, IL 60085-6101
(847) 782-4130
(847) 782-1030
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.006690
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669583001
—
IL
Enumeration date
05/24/2016
Last updated
05/24/2016
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