Provider Demographics
NPI:1235613332
Name:FREDRICKSON, HANNA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2333
Mailing Address - Country:US
Mailing Address - Phone:559-368-5432
Mailing Address - Fax:
Practice Address - Street 1:1839 N ECHO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-6047
Practice Address - Country:US
Practice Address - Phone:559-368-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000095492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty