Active NPI
Alan Fredericksen, M.A., CADC
- Addiction (Substance Use Disorder) Counselor
- Sioux City, IA
National Provider Identifier
1184035461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 14019
- Practice address
- 1221 Pierce St
Sioux City, IA 51105-1418 - Phone
- (712) 255-0204
- NPI assigned
- May 8, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 14019 | IA | Primary |
Addresses
Primary practice location
1221 Pierce St
Sioux City, IA 51105-1418
Mailing address
1221 Pierce St.
Sioux City, IA 51105
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14019 | IA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399507200000",
"number": "1184035461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 PIERCE ST.",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "51105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 PIERCE ST",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "511051418",
"telephone_number": "712-255-0204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICKSEN",
"first_name": "ALAN",
"credential": "M.A., CADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-08",
"last_updated": "2014-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IA",
"license": "14019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sioux City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.