Provider Demographics
NPI:1649670738
Name:FREI, SONJA MARIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:MARIE
Last Name:FREI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MINONK
Mailing Address - State:IL
Mailing Address - Zip Code:61760-1429
Mailing Address - Country:US
Mailing Address - Phone:309-532-2139
Mailing Address - Fax:
Practice Address - Street 1:905 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760-1429
Practice Address - Country:US
Practice Address - Phone:309-532-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227003078175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath