Provider Demographics
NPI:1043268162
Name:FREDERICK, JANICE MARIE (HIS)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10831 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3311
Mailing Address - Country:US
Mailing Address - Phone:804-716-6752
Mailing Address - Fax:804-716-6754
Practice Address - Street 1:10831 W BROAD ST
Practice Address - Street 2:HEARING CONCEPTS
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-716-6752
Practice Address - Fax:804-716-6754
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001136796163W00000X
VA2101002102237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No163W00000XNursing Service ProvidersRegistered Nurse