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General NPI Number Information
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NPI Number | 1255821997
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Entity Type | Organization
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Legal Business Name | FREDERICKSEN NATUROPATHIC CLINIC, PS INC
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 2003 MAPLE VALLEY HWY STE 212
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City | RENTON
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State | WA
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Zip | 98057-3925
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Country | US
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Telephone | 425-652-2430
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Fax | 425-291-7899
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Provider Business Mailing Address
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Address Line | 2003 MAPLE VALLEY HWY STE 212
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City | RENTON
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State | WA
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Zip | 98057-3925
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Country | US
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Telephone | 425-652-2430
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK FREDERICKSEN
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Credential | ND
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Telephone | 425-652-2430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 00000737
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License Number State | WA
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