MEDICARE: SHAWN FREDERICK MS

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
1	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154644037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN FREDERICK MS

Provider Business Mailing Address
First Line	:	424 WASHINGTON ST
Second Line	:	SUITE 7
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6790
Country	:	US
Telephone Number	:	812-799-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 WASHINGTON ST
Second Line	:	SUITE 7
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6790
Country	:	US
Telephone Number	:	812-799-1350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	05/02/2013

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Directions to “ SHAWN FREDERICK MS” Practice Location

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