Provider Demographics
NPI:1043958366
Name:FREDRICKSON, AIMEE (MSW, SSW)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:MSW, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-5444
Mailing Address - Country:US
Mailing Address - Phone:307-851-3902
Mailing Address - Fax:
Practice Address - Street 1:121 N 5TH ST W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3453
Practice Address - Country:US
Practice Address - Phone:307-856-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool