Individual
TRENTON D FEDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
550 S PEORIA AVE, TULSA, OK 74120-3820
(918) 588-1900
Mailing address
6500 N GLENWOOD AVE APT 103, CHICAGO, IL 60626-5154
(773) 386-4833
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14583
IL
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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