Tasha Jane Frederick

NPI #1255934485 in Portage, Michigan

Provider Information

NPI Number: 1255934485
Entity Type: Individual
Name: Tasha Jane Frederick
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Nov 19, 2020
Last Updated: Nov 19, 2020

Practice Location

Address: 526 W CENTRE AVE
City: Portage
State: Michigan
ZIP Code: 49024-5306
Phone: (269) 321-9556

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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