Provider Demographics
NPI:1316004534
Name:FREDERIKSEN, ULLA H (LLP)
Entity Type:Individual
Prefix:
First Name:ULLA
Middle Name:H
Last Name:FREDERIKSEN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4660
Mailing Address - Country:US
Mailing Address - Phone:269-226-2400
Mailing Address - Fax:269-226-2403
Practice Address - Street 1:813 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4660
Practice Address - Country:US
Practice Address - Phone:269-226-2400
Practice Address - Fax:269-226-2403
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical