Provider Demographics
NPI:1336314699
Name:HIDDEN FRIEND, TRESSA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRESSA
Middle Name:J
Last Name:HIDDEN FRIEND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TRESSA
Other - Middle Name:J
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3501 BRADSHAW RD
Mailing Address - Street 2:SPACE 55
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3325
Mailing Address - Country:US
Mailing Address - Phone:409-673-2284
Mailing Address - Fax:
Practice Address - Street 1:3501 BRADSHAW RD
Practice Address - Street 2:SPACE 55
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3325
Practice Address - Country:US
Practice Address - Phone:409-673-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320620-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist