Basic Information
| Provider Information | |||||||||
| NPI: | 1477711778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FROESE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DENICE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761041017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173352583 | ||||||||
| FaxNumber: | 8173352597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1730 W RANDOL MILL RD | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760123054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172651466 | ||||||||
| FaxNumber: | 8174590756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 51183 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | 51183 | TX | N | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.