Active NPI
Holly Fredrickson, M.S. CCC-SLP
- Speech-Language Pathologist
- Baltimore, MD
National Provider Identifier
1003169517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 06881
- Practice address
- 3855 Greenspring Ave
Baltimore, MD 21211-3300 - Phone
- (410) 225-9160
- NPI assigned
- Oct 22, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 06881 | MD | Primary |
Addresses
Primary practice location
3855 Greenspring Ave
Baltimore, MD 21211-3300
Mailing address
218 N Charles St
Apt. #2201
Baltimore, MD 21201-4021
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AHN811170124 | Other | MD | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06881 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350864000000",
"number": "1003169517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 N CHARLES ST",
"address_2": "APT. #2201",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212014021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3855 GREENSPRING AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212113300",
"telephone_number": "410-225-9160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRICKSON",
"first_name": "HOLLY",
"name_prefix": "Ms.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-22",
"last_updated": "2012-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "06881",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "AHN811170124",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.