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1740815182
KELLY FREDERIKSEN
GRANITE BAY, CA
NPI
1740815182
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106E00000X Assistant Behavior Analyst
Enumeration Date
2020-03-05
Last Update Date
2020-03-05
Business Address
KELLY FREDERIKSEN
4196 DOUGLAS BLVD STE 100
GRANITE BAY, CA 95746-5904
Phone number: 916-489-1376
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Mailing Address
KELLY FREDERIKSEN
PO BOX 5157
MODESTO, CA 95352-5157
Phone number: 209-572-2589
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