Individual
BREEANA LEE FREDRICKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17986 COPPEROPOLIS RD, STOCKTON, CA 95215-9717
(208) 993-3469
Mailing address
17986 COPPEROPOLIS RD, STOCKTON, CA 95215-9717
(208) 993-3469
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
2355S0801X
Speech-Language Assistant
Primary
SPA8402
CA
Other
Enumeration date
10/07/2024
Last updated
05/21/2026
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