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General NPI Number Information
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NPI Number | 1699223214
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Entity Type | Individual
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Provider Name | STEPHANIE FREDRICK PHD, LLP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 1101 HEALTH PROFESSIONS BLDG
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City | MT PLEASANT
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State | MI
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Zip | 48859-0001
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Country | US
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Telephone | 989-774-3904
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Fax | 989-774-1891
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Provider Business Mailing Address
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Address Line | 1101 HEALTH PROFESSIONS BLDG
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City | MT PLEASANT
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State | MI
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Zip | 48859-0001
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Country | US
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Telephone | 989-774-3904
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Fax | 989-774-1891
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 6301016859
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License Number State | MI
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