Individual
MR. TIMOTHY FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
660 W WASHINGTON AVE, MADISON, WI 53703-4703
(608) 444-5106
Mailing address
PO BOX 294, STOUGHTON, WI 53589-0294
(608) 444-5106
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
11167-125
WI
Other
Enumeration date
04/05/2023
Last updated
09/10/2024
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