Healthcare Provider Details

I. General information

NPI: 1265952238
Provider Name (Legal Business Name): CHRISTINE FREDRICKSON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 C ST
SACRAMENTO CA
95816-3326
US

IV. Provider business mailing address

3031 C ST
SACRAMENTO CA
95816-3326
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-2396
  • Fax: 916-442-2525
Mailing address:
  • Phone: 916-442-2396
  • Fax: 916-442-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-20-44108
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-08370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: