Kyle Fredrik Freeman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L6011 Issued in OR

Practice address

20942 Spinnaker St
Bend, OR 97701-8428

Phone

(541) 640-1160

NPI assigned

Dec 18, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OR

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1588727770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20942 SPINNAKER ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977018428",
            "telephone_number": "541-640-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20942 SPINNAKER ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977018428",
            "telephone_number": "541-640-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "KYLE",
        "middle_name": "FREDRIK",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "HB994A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fred Meyer Stores Inc
• Jessica House Fredeen, PA-C
• David A. Fredstrom, M.D.
• Fantasia Freedom, LMT
• Jamie Janelle Freeman, PAC
• Michele Marie Freeman, NCC, LPC
• Paul Thomas Freeman, PT
• Phillippe C Freeman, DMD, FAGD
• Gary John Frei, M.D.
• Brolen Freimanis, DDS

• Clinical Social Worker in Bend, OR
• Providers in Bend, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.