Provider Demographics
NPI:1720399777
Name:FRIEDRICHSEN, TAMARRA A (AUD)
Entity Type:Individual
Prefix:
First Name:TAMARRA
Middle Name:A
Last Name:FRIEDRICHSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 52ND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6389
Mailing Address - Country:US
Mailing Address - Phone:309-762-6467
Mailing Address - Fax:309-762-7218
Practice Address - Street 1:1601 52ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6389
Practice Address - Country:US
Practice Address - Phone:309-762-6467
Practice Address - Fax:309-762-7218
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001004237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist