| Doctor Name: | MARY ANN FREDRICKSON |
| NPI Number: | 1033449053 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW-PIP |
| License Number: | 2423 |
| Business Practice Address: | 353 Fairmont Blvd. Rapid City, SD - 57701 |
| Business Phone Number: | 6057192300 |
| Business Fax Number: | 6057192310 |
| Mailing Address: | 353 Fairmont Blvd, Atten Christie Mss RAPID CITY |
| State: | SD |
| Postal Code: | 577017350 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2010 |
| NPI Last Update Date: | 06/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2423 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |