MEDICARE: FRAYDA FRIEDMAN MS CCC-SLP

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	41YS00524600	NJ

General Provider Information

NPI Number	:	1457651812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRAYDA FRIEDMAN MS CCC-SLP

Provider Business Mailing Address
First Line	:	1242 CORONADO ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2210
Country	:	US
Telephone Number	:	732-232-7361
Fax Number	:	732-886-8251

Provider Business Practice Location Address
First Line	:	1242 CORONADO ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2210
Country	:	US
Telephone Number	:	732-232-7361
Fax Number	:	732-886-8251

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	12/11/2013

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