Provider Demographics
NPI:1134525892
Name:FREDERIKSEN, BRANDY (AAHCC)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:FREDERIKSEN
Suffix:
Gender:F
Credentials:AAHCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1431
Mailing Address - Country:US
Mailing Address - Phone:513-680-8844
Mailing Address - Fax:
Practice Address - Street 1:924 SENECA DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-680-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator