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General NPI Number Information
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NPI Number | 1548646979
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Entity Type | Individual
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Provider Name | GEREON J FREDRICKSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 12173 S TALLKID CT
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City | PARKER
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State | CO
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Zip | 80138-8813
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Country | US
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Telephone | 720-334-2526
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Fax |
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Provider Business Mailing Address
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Address Line | 12173 S TALLKID CT
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City | PARKER
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State | CO
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Zip | 80138-8813
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Country | US
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Telephone | 720-334-2526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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