Individual
DANIELLE DEFREESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-6839
Mailing address
N84W16889 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2810
(414) 454-6779
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3275
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100048177
—
WI
Enumeration date
06/03/2011
Last updated
11/30/2021
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