Provider Demographics
NPI:1023707411
Name:FRISCHKNECHT, KARLIE NOEL
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:NOEL
Last Name:FRISCHKNECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:NOEL
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REMARRIED
Mailing Address - Street 1:13826 MEYERS RD APT 2049
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7919
Mailing Address - Country:US
Mailing Address - Phone:503-545-0588
Mailing Address - Fax:
Practice Address - Street 1:13826 MEYERS RD APT 2049
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7919
Practice Address - Country:US
Practice Address - Phone:503-545-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician