MEDICARE: CHRISTINE FREDERICK SPEECH THERAPIST LLC

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	:	1366317729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE FREDERICK SPEECH THERAPIST LLC

Provider Business Mailing Address
First Line	:	3162 STRATFORD GREEN PL
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3162 STRATFORD GREEN PL
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1341
Country	:	US
Telephone Number	:	770-000-0000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTINE FREDERICK
Credential	:
Telephone Number	:	770-000-0000

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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Directions to “CHRISTINE FREDERICK SPEECH THERAPIST LLC ” Practice Location

Language	Start Address	Practice Location

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