Provider Demographics
NPI:1225303274
Name:FRERICKS, MEGAN ELIZABETH (HAS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:FRERICKS
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 BROKEN SOUND PARKWAY NW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3638
Mailing Address - Country:US
Mailing Address - Phone:561-367-1623
Mailing Address - Fax:561-299-5438
Practice Address - Street 1:13350 REFLECTIONS PARKWAY
Practice Address - Street 2:SUITE 4-402
Practice Address - City:FORT MEYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-6539
Practice Address - Country:US
Practice Address - Phone:239-936-1110
Practice Address - Fax:239-437-9589
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X
FLAS4855237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100565700Medicaid