Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | RC00051356 | WA |
NPI | 1003018839 |
---|---|
Provider Name | Cindy Marie Frederickson |
First Address | Snohomish, WA 98296-8721 |
Second Address | Marysville, WA 98270-4335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 16/05/2012 |