Healthcare Provider Details

I. General information

NPI: 1932021961
Provider Name (Legal Business Name): CHASSIDI FREDERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N CHIPPER LN
WICHITA KS
67212-4209
US

IV. Provider business mailing address

1151 N CHIPPER LN
WICHITA KS
67212-4209
US

V. Phone/Fax

Practice location:
  • Phone: 316-648-2659
  • Fax:
Mailing address:
  • Phone: 316-648-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: