| NPI | 1851618763 |
|---|---|
| Former Name | KRISTEN LYNN FREDRICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 806) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 0829) |
| 101YM0800X Counselor, Mental Health (Licence: MA 6046) | |
| Enumeration Date | 2010-05-02 |
| Last Update Date | 2013-08-13 |