NPI | 1922331883 |
---|---|
Former Name | ANGELA M FREDRICKS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MO 2006010653) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NE 2658) |
Enumeration Date | 2009-09-10 |
Last Update Date | 2024-09-26 |