Provider Demographics
NPI:1699390559
Name:FRAEDRICH, REBECCA MARIE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:FRAEDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:WEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1025
Mailing Address - Country:US
Mailing Address - Phone:815-508-5181
Mailing Address - Fax:
Practice Address - Street 1:225 EDWARD ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2137
Practice Address - Country:US
Practice Address - Phone:815-895-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005876235Z00000X
IL146.015952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist