Individual
JESSICA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
313 S 5TH ST, ODESSA, DE 19730-2078
(302) 376-4128
Mailing address
313 S 5TH ST, ODESSA, DE 19730-2078
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
88798
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88798
STATE OF DELAWARE
DE
Enumeration date
06/14/2018
Last updated
06/14/2018
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