Individual
KELLY K FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
10267664
IN
106S00000X
Behavior Technician
RBT-19-78150
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10267664
INDIANA DEPARTMENT OF EDUCATION
IN
Enumeration date
04/25/2019
Last updated
08/19/2021
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