Basic Information
| Provider Information | |||||||||
| NPI: | 1922610278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREDETTE | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HAYDEN BRIDGE WAY | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974771347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418689430 | ||||||||
| FaxNumber: | 5418689450 | ||||||||
| Practice Location | |||||||||
| Address1: | 34182 THUNDER CLOUD DR | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974059632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415148009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2020 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 012076 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.