Individual
DEA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
50274 ANTIOCH RD, TICKFAW, LA 70466-1730
(985) 373-5448
Mailing address
50274 ANTIOCH RD, TICKFAW, LA 70466-1730
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5413
LA
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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