Healthcare Provider Details

I. General information

NPI: 1518067917
Provider Name (Legal Business Name): LEILA FREDERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 N DIVISION SUITE B
SPOKANE WA
99202
US

IV. Provider business mailing address

5000 CHESHIRE LANE NORTH
PLYMOUTH MN
55446
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-7078
  • Fax:
Mailing address:
  • Phone: 888-333-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00003450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: