Individual
NIKKI FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1308 NW 20TH AVE STE 7, PORTLAND, OR 97209-1607
(801) 678-8375
Mailing address
1890 SW GOLF CREEK DR APT H, PORTLAND, OR 97225-7304
(801) 678-8375
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3016
OR
Other
Enumeration date
09/11/2015
Last updated
03/01/2024
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