Basic Information
Provider Information
NPI: 1306590542
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRIKER
FirstName: LINDSAY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RBT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2620 FORUM BLVD STE E
Address2:  
City: COLUMBIA
State: MO
PostalCode: 652035454
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2620 FORUM BLVD STE E
Address2:  
City: COLUMBIA
State: MO
PostalCode: 652035454
CountryCode: US
TelephoneNumber: 5735148735
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/07/2022
LastUpdateDate: 02/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X106S00000XMOY    

No ID Information.


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