Individual
MRS. MELYSSA J FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
396 BENBOW CT, BALLWIN, MO 63011-2541
(636) 207-7878
(636) 207-7869
Mailing address
396 BENBOW CT, BALLWIN, MO 63011-2541
(636) 207-7878
(636) 207-7869
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005968
MO
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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