Individual
MS. JANN R. FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA L.I.C.S.W.
Contact information
Practice address
303 21ST ST, SUITE 209, NEWPORT, MN 55055-1094
(651) 208-6458
Mailing address
303 21ST ST, SUITE 209, NEWPORT, MN 55055-1094
(651) 208-6458
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
08938
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08938
STATE LICENSURE
MN
Enumeration date
01/25/2007
Last updated
07/08/2007
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