Individual
DR. NICHOLAS FREDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1595 WELD RD STE 5, ELGIN, IL 60123-5896
(262) 308-6257
Mailing address
5558 W EDMUNDS ST APT 1, CHICAGO, IL 60630-4698
(262) 308-6257
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071010033
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071010033
CLINICAL PSYCHOLOGIST LICENSE
IL
Enumeration date
09/15/2010
Last updated
05/14/2019
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