Julie D. Frederick, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1006 Issued in OR

Practice address

9900 SW Wilshire St
Suite 160
Portland, OR 97225-5035

Phone

(503) 894-9255

Fax

(503) 385-0343

NPI assigned

Nov 8, 2005

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Akots and Frederick PC

  • Psychologist
  • Portland, OR
  • NPI 1780855270
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 25, 2025 through Feb 25, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 22, 2015.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434931200000",
    "number": "1487635363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 SW WILSHIRE ST",
            "address_2": "SUITE 160",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255035",
            "telephone_number": "503-894-9255",
            "fax_number": "503-385-0343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 SW WILSHIRE ST",
            "address_2": "SUITE 160",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255035",
            "telephone_number": "503-894-9255",
            "fax_number": "503-385-0343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "JULIE",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2015-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035142",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Desiree Fredenburg, LMT
• Frederick T Waller MD PC
• Brent Frederick, RPH
• Carrie E. Frederick, MD
• Eric J Frederick, AU.D
• Kate R Frederick, RPH
• Meredith Claire Frederick, M.D.
• Nikki Frederick, PH.D.
• Erin Fredericks, MSCN
• Linda Joyce Thimsen Fredericks, FNP

• All providers in Portland, OR
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.