Active NPI
Kristine Ellen Freeark-Zucker, PH.D.
- Clinical Psychologist
- Ann Arbor, MI
National Provider Identifier
1508995127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301002719
- Practice address
- 916 Fuller St
Ann Arbor, MI 48104-1215 - Phone
- (734) 668-0140
- Fax
- (734) 995-1172
- NPI assigned
- Mar 2, 2007
- Last updated
- Aug 5, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301002719 | MI | Primary |
Addresses
Primary practice location
916 Fuller St
Ann Arbor, MI 48104-1215
Mailing address
3525 Daleview Dr
Ann Arbor, MI 48105-9686
Phone (734) 668-0140
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11276437 | Other | MI | CAQH PROVIDER ID |
| 68-0-H1-4729-0 | Other | MI | BCBS PROVIDER ID |
| 61-20013 | Other | MI | PHPSM,UNITED HEALTHCARE |
Other names 1
- Dr. Kristine Freeark
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301002719 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249430400000",
"number": "1508995127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3525 DALEVIEW DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481059686",
"telephone_number": "734-668-0140",
"fax_number": "734-995-1172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "916 FULLER ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481041215",
"telephone_number": "734-668-0140",
"fax_number": "734-995-1172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREEARK-ZUCKER",
"first_name": "KRISTINE",
"middle_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-02",
"last_updated": "2009-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301002719",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH PROVIDER ID",
"identifier": "11276437",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER ID",
"identifier": "68-0-H1-4729-0",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHPSM,UNITED HEALTHCARE",
"identifier": "61-20013",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTINE",
"last_name": "FREEARK",
"prefix": "DR.",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.