Provider Demographics
NPI:1801518071
Name:FRIDRIKSSON, ASTRID M (SLP)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:M
Last Name:FRIDRIKSSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ASTRID
Other - Middle Name:M
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3711 WHEAT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2832
Mailing Address - Country:US
Mailing Address - Phone:803-319-7244
Mailing Address - Fax:
Practice Address - Street 1:5422 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3892
Practice Address - Country:US
Practice Address - Phone:803-756-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist