| J L Fristad Pllc | |
|
2 Cardinal Park Dr Se Ste 104a Leesburg VA 20175-4448 | |
| (703) 980-9715 | |
| Not Available |
| Full Name | J L Fristad Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2 Cardinal Park Dr Se Ste 104a, Leesburg, Virginia |
| Authorized Official Name and Position | Janice L Fristad (EXECUTIVE OFFICER) |
| Authorized Official Contact | 7034746202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J L Fristad Pllc 1206 Musket Ct Ne Leesburg VA 20176-4805 Ph: (703) 474-6202 | J L Fristad Pllc 2 Cardinal Park Dr Se Ste 104a Leesburg VA 20175-4448 Ph: (703) 980-9715 |
| NPI Number | 1487148490 |
|---|---|
| Provider Enumeration Date | 06/22/2018 |
| Last Update Date | 09/14/2022 |
| Certification Date | 09/14/2022 |
| Medicare PECOS PAC ID | 7719236942 |
|---|---|
| Medicare Enrollment ID | O20180822001063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487148490 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Janice Louise Fristad |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679817548 PECOS PAC ID: 0345485132 Enrollment ID: I20130327000333 |
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