Active NPI
Kristina W Fredette
- Speech-Language Pathologist
- Eugene, OR
National Provider Identifier
1922610278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 012076
- Practice address
- 34182 Thunder Cloud Dr
Eugene, OR 97405-9632 - Phone
- (541) 514-8009
- NPI assigned
- Aug 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 012076 | OR | Primary |
Addresses
Primary practice location
34182 Thunder Cloud Dr
Eugene, OR 97405-9632
Mailing address
1 Hayden Bridge Way
Springfield, OR 97477-1347
Phone (541) 868-9430
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012076 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632182400000",
"number": "1922610278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 HAYDEN BRIDGE WAY",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974771347",
"telephone_number": "541-868-9430",
"fax_number": "541-868-9450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34182 THUNDER CLOUD DR",
"city": "EUGENE",
"state": "OR",
"postal_code": "974059632",
"telephone_number": "541-514-8009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDETTE",
"first_name": "KRISTINA",
"middle_name": "W",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-18",
"last_updated": "2021-09-21",
"certification_date": "2021-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "012076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.