Provider Demographics
NPI:1992089288
Name:FREDERICK, EILEEN (MS SLP-CCC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:COEYMANS
Mailing Address - State:NY
Mailing Address - Zip Code:12045
Mailing Address - Country:US
Mailing Address - Phone:518-756-5200
Mailing Address - Fax:
Practice Address - Street 1:2008 CARDIFF RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-3073
Practice Address - Country:US
Practice Address - Phone:518-461-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist