MEDICARE: FELICIA ANN FREDD SLPA

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	2355S0801X	Speech-Language Assistant	6116	NM

General Provider Information

NPI Number	:	1851823736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA ANN FREDD SLPA

Provider Business Mailing Address
First Line	:	PO BOX 938
Second Line	:
City	:	SANTA CRUZ
State	:	NM
Zip	:	87567-0938
Country	:	US
Telephone Number	:	505-316-0392
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 YUCCA ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5456
Country	:	US
Telephone Number	:	505-467-2400
Fax Number	:

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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Directions to “ FELICIA ANN FREDD SLPA” Practice Location

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