Provider Demographics
NPI:1376532044
Name:FREDERICK, ELLEN ALVAREZ (M AUD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ALVAREZ
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:M AUD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 ASHVILLE AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6660
Mailing Address - Country:US
Mailing Address - Phone:919-803-8618
Mailing Address - Fax:919-803-8638
Practice Address - Street 1:226 ASHVILLE AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6660
Practice Address - Country:US
Practice Address - Phone:919-803-8618
Practice Address - Fax:919-803-8638
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00736231H00000X
NC10852231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
61142901OtherCAREFIRST BCBS
6331959OtherCIGNA
6331959OtherCIGNA