Provider Demographics
NPI:1730308164
Name:C A FREDERICK LTD
Entity Type:Organization
Organization Name:C A FREDERICK LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-SPEECH LANGUAGE PATHOLOGI
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREDERICKFARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:773-330-4717
Mailing Address - Street 1:40 N. MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644
Mailing Address - Country:US
Mailing Address - Phone:773-330-4717
Mailing Address - Fax:
Practice Address - Street 1:40 N. MASON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644
Practice Address - Country:US
Practice Address - Phone:773-330-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty