Provider Demographics
NPI:1457746455
Name:FREDERICKS, NAYELI AIDE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NAYELI
Middle Name:AIDE
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MISS
Other - First Name:NAYELI
Other - Middle Name:AIDE
Other - Last Name:BECERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2910 E 57TH AVE # 5-108
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7028
Mailing Address - Country:US
Mailing Address - Phone:509-795-1967
Mailing Address - Fax:
Practice Address - Street 1:6608 S MEADOW ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-8495
Practice Address - Country:US
Practice Address - Phone:775-762-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2021-05-13
Deactivation Date:2021-03-25
Deactivation Code:
Reactivation Date:2021-05-13
Provider Licenses
StateLicense IDTaxonomies
WA60759865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst