Provider Demographics
NPI:1659851624
Name:FRECHETTE, ROBERTA SUZANNE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:SUZANNE
Last Name:FRECHETTE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 WOODLYN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6967
Mailing Address - Country:US
Mailing Address - Phone:301-514-6962
Mailing Address - Fax:
Practice Address - Street 1:6012 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6953
Practice Address - Country:US
Practice Address - Phone:301-371-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist