Provider Demographics
NPI:1053592907
Name:FRERICKS, KATHERINE (AUD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FRERICKS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1461
Mailing Address - Country:US
Mailing Address - Phone:712-623-4802
Mailing Address - Fax:
Practice Address - Street 1:1010 N BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1461
Practice Address - Country:US
Practice Address - Phone:712-623-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001255231H00000X
IA089609237700000X
IA088919231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001OtherDMERC
IL6447860011Medicare NSC
ILIL3270286Medicare PIN
ILK49534Medicare PIN