Provider Demographics
NPI:1285891770
Name:MCDONALD, FREDRIKA STETSON
Entity type:Individual
Prefix:
First Name:FREDRIKA
Middle Name:STETSON
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIKA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:165 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1131
Mailing Address - Country:US
Mailing Address - Phone:973-334-3214
Mailing Address - Fax:
Practice Address - Street 1:556 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1503
Practice Address - Country:US
Practice Address - Phone:073-226-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA00046000231H00000X
NJMG00077900237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter