Healthcare Provider Details

I. General information

NPI: 1851823736
Provider Name (Legal Business Name): FELICIA ANN FREDD SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 YUCCA ST
SANTA FE NM
87505-5456
US

IV. Provider business mailing address

PO BOX 938
SANTA CRUZ NM
87567-0938
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2400
  • Fax:
Mailing address:
  • Phone: 505-316-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6116
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: