MEDICARE: KATHRYN FREDBLOOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1578405775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN FREDBLOOM

Provider Business Mailing Address
First Line	:	3823 E STATE ROAD 64
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-9041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 E STATE ROAD 64
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-9041
Country	:	US
Telephone Number	:	941-745-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ KATHRYN FREDBLOOM ” Practice Location

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