Individual
DR. AUDREY MAE FREDERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY D
Contact information
Practice address
5200 MAYWOOD RD, SUITE 202, MOUND, MN 55364-1775
(952) 472-2408
(952) 495-1409
Mailing address
5200 MAYWOOD RD, SUITE 202, MOUND, MN 55364-1775
(952) 472-2408
(952) 495-1409
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4856
MN
Other
Enumeration date
08/03/2006
Last updated
11/13/2009
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