Provider Demographics
NPI:1447369186
Name:FREDRICKSON, KRIS RENEE (MSW)
Entity type:Individual
Prefix:MS
First Name:KRIS
Middle Name:RENEE
Last Name:FREDRICKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:RENEE
Other - Last Name:FREDRICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2188
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:S-182-SW
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2188
Practice Address - Fax:206-764-2477
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical