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NPI Code Detail

MEDICARE: MS. DECEMBER FREDERICK

MEDICARE: MS. DECEMBER FREDERICK
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
12355S0801XSpeech-Language Assistant35413TX
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1780048546
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DECEMBER FREDERICK
Provider Business Mailing Address
First Line : 4528 NEWCASTLE DR
Second Line :
City : FRISCO
State : TX
Zip : 75034-8403
Country : US
Telephone Number : 817-680-1388
Fax Number :
Provider Business Practice Location Address
First Line : 12770 COIT RD STE 870
Second Line :
City : DALLAS
State : TX
Zip : 75251-1455
Country : US
Telephone Number : 972-756-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2016
Last Update Date : 07/20/2021

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Directions to “ MS. DECEMBER FREDERICK ” Practice Location

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