Individual
BEVERLY FREDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S CHARLES ST, CALMAR, IA 52132-7858
(563) 380-9242
Mailing address
PO BOX 225, DECORAH, IA 52101-0225
(563) 380-9242
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
X000705575
—
IA
Enumeration date
10/06/2014
Last updated
10/06/2014
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