Provider Demographics
NPI:1902969702
Name:FREY, JANA LANE (PHD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:LANE
Last Name:FREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILLIAMSON ST
Mailing Address - Street 2:SUITE A-B
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3588
Mailing Address - Country:US
Mailing Address - Phone:608-266-2567
Mailing Address - Fax:608-266-3638
Practice Address - Street 1:600 WILLIAMSON ST
Practice Address - Street 2:SUITE A-B
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3588
Practice Address - Country:US
Practice Address - Phone:608-266-2567
Practice Address - Fax:608-266-3638
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist