Individual
JOSHUA LEE FREDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, CBIS
Contact information
Practice address
6724 43RD AVE N, CRYSTAL, MN 55428-5239
(612) 309-8183
Mailing address
6724 43RD AVE N, CRYSTAL, MN 55428-5239
(612) 309-8183
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303295
MN
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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