Basic Information
| Provider Information | |||||||||
| NPI: | 1225303274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRERICKS | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | HAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 BROKEN SOUND PARKWAY NW | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613671623 | ||||||||
| FaxNumber: | 5612995438 | ||||||||
| Practice Location | |||||||||
| Address1: | 13350 REFLECTIONS PARKWAY | ||||||||
| Address2: | SUITE 4-402 | ||||||||
| City: | FORT MEYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339076539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399361110 | ||||||||
| FaxNumber: | 2394379589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | AS4855 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 100565700 | 05 | FL | MEDICAID |