Provider Demographics
NPI:1215591813
Name:FREDRICKSON, TRICIA ELIZABETH
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:ELIZABETH
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3702
Mailing Address - Country:US
Mailing Address - Phone:907-374-1686
Mailing Address - Fax:866-308-4995
Practice Address - Street 1:3065 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3702
Practice Address - Country:US
Practice Address - Phone:907-374-1686
Practice Address - Fax:866-308-4995
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist