Individual
JORDAN FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2825 WESTRIDGE OAKS CT, GROVER, MO 63040-1130
(314) 706-0655
Mailing address
2825 WESTRIDGE OAKS CT, GROVER, MO 63040-1130
(314) 706-0655
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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