Organization
ELLEN G. FREDERICKS PHD., L.P., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN G. FREDERICKS PHD (OWNER)
(734) 692-2696
Entity
Organization
Contact information
Practice address
1545 KINGSWAY CT, SUITE 201A, TRENTON, MI 48183-1952
(734) 692-2696
Mailing address
1545 KINGSWAY CT, SUITE 201A, TRENTON, MI 48183-1952
(734) 692-2696
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301002524
MI
Other
Enumeration date
11/11/2006
Last updated
04/20/2008
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