Provider Demographics
NPI:1891242897
Name:FREDRICKS, AERICA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AERICA
Middle Name:
Last Name:FREDRICKS
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 1:42 ROCK CANDY LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-4321
Mailing Address - Country:US
Mailing Address - Phone:518-522-0193
Mailing Address - Fax:
Practice Address - Street 1:120 MADALON HICKEY WAY
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2339
Practice Address - Country:US
Practice Address - Phone:518-233-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025800-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist