Healthcare Provider Details

I. General information

NPI: 1548646979
Provider Name (Legal Business Name): GEREON J FREDRICKSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12173 S TALLKID CT
PARKER CO
80138-8813
US

IV. Provider business mailing address

12173 S TALLKID CT
PARKER CO
80138-8813
US

V. Phone/Fax

Practice location:
  • Phone: 720-334-2526
  • Fax:
Mailing address:
  • Phone: 720-334-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: