Individual
DR. MARY G FREITAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD LP
Contact information
Practice address
10480 PERKINS AVE N, STILLWATER, MN 55082-9273
(651) 357-3216
(651) 730-6657
Mailing address
10480 PERKINS AVE N, STILLWATER, MN 55082-9273
(651) 357-3216
(651) 730-6657
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4319
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014959400
MEDICAL ASSISTANCE MHCP
MN
01
—
028H0HA
BCBS
MN
01
—
028H1FR
BCBS
MN
05
—
0492456
—
MN
01
—
1028022
MENTAL HEALTH
MN
01
—
130952
U CARE
MN
01
—
20358-02
BHP
MN
01
—
6151196
UBH
—
01
—
HP 33776
MENTAL HEALTH
MN
Enumeration date
01/12/2007
Last updated
10/25/2019
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