| Ellen G. Fredericks Phd., L.p., P.c. | |
|
1545 Kingsway Ct Suite 201a Trenton MI 48183-1952 | |
| (734) 692-2696 | |
| Not Available |
| Full Name | Ellen G. Fredericks Phd., L.p., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1545 Kingsway Ct, Trenton, Michigan |
| Authorized Official Name and Position | Ellen G. Fredericks (OWNER) |
| Authorized Official Contact | 7346922696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen G. Fredericks Phd., L.p., P.c. 1545 Kingsway Ct Suite 201a Trenton MI 48183-1952 Ph: (734) 692-2696 | Ellen G. Fredericks Phd., L.p., P.c. 1545 Kingsway Ct Suite 201a Trenton MI 48183-1952 Ph: (734) 692-2696 |
| NPI Number | 1932270048 |
|---|---|
| Provider Enumeration Date | 11/11/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 2062513377 |
|---|---|
| Medicare Enrollment ID | O20070730000783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932270048 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301002524 (Michigan) | Primary |
| Provider Name | Ellen G Fredericks |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437260247 PECOS PAC ID: 4880795194 Enrollment ID: I20070730000772 |
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