Individual
MARGUERITE EOWYN FREDERICKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
545 N WOODLAWN ST, WICHITA, KS 67208-3645
(316) 260-6889
Mailing address
644 TROTTER ST, MAIZE, KS 67101-9649
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
01135-T
KS
101YP2500X
Professional Counselor
Primary
04330
KS
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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