Provider Demographics
NPI:1962522920
Name:FREDRICKSON, CATHERINE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13336 SW SCOTTS BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7812
Mailing Address - Country:US
Mailing Address - Phone:503-524-9980
Mailing Address - Fax:
Practice Address - Street 1:13336 SW SCOTTS BRIDGE DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-7812
Practice Address - Country:US
Practice Address - Phone:503-524-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist