MEDICARE: EMILY FREDERICKS

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1316620750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY FREDERICKS

Provider Business Mailing Address
First Line	:	1414 ARMSTRONG LN
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3158
Country	:	US
Telephone Number	:	847-770-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 ARMSTRONG LN
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3158
Country	:	US
Telephone Number	:	847-357-5200
Fax Number	:

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

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “ EMILY FREDERICKS ” Practice Location

Language	Start Address	Practice Location

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