Provider Demographics
NPI:1548654031
Name:FREUDENTHALER, TAWNYA (CADCI)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:
Last Name:FREUDENTHALER
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:TAWNYA
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCI
Mailing Address - Street 1:418 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-450-9615
Mailing Address - Fax:
Practice Address - Street 1:418 SW 6TH STREET
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-450-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR93-1200332101YA0400X
OR16-02-19101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1871703702Medicaid