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NPI Code Detail

MEDICARE: MRS. LORI SUSANNE FREDERICK M.A., CCC-A

MEDICARE: MRS. LORI SUSANNE FREDERICK M.A., CCC-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1237600000XAudiologist-Hearing Aid FitterA0000001325TN

General Provider Information

NPI Number : 1134385024
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORI SUSANNE FREDERICK M.A., CCC-A
Provider Business Mailing Address
First Line : 6242 POPLAR AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-4730
Country : US
Telephone Number : 901-842-4327
Fax Number : 901-842-4330
Provider Business Practice Location Address
First Line : 6242 POPLAR AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-4730
Country : US
Telephone Number : 901-842-4327
Fax Number : 901-842-4330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2008
Last Update Date : 07/31/2008

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