| Wendy Fredrickson Trudeau, Lisw-cp | |
|
130 E Richardson Ave Summerville SC 29483-6333 | |
| (803) 397-5010 | |
| (866) 871-8001 |
| Full Name | Wendy Fredrickson Trudeau, Lisw-cp |
|---|---|
| Speciality | Social Worker |
| Location | 130 E Richardson Ave, Summerville, South Carolina |
| Authorized Official Name and Position | Wendy Fredrickson Trudeau (SOLE PROPRIETOR) |
| Authorized Official Contact | 8033975010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wendy Fredrickson Trudeau, Lisw-cp 130 E Richardson Ave Summerville SC 29483-6333 Ph: (803) 397-5010 | Wendy Fredrickson Trudeau, Lisw-cp 130 E Richardson Ave Summerville SC 29483-6333 Ph: (803) 397-5010 |
| NPI Number | 1659720266 |
|---|---|
| Provider Enumeration Date | 06/06/2016 |
| Last Update Date | 06/07/2016 |
| Medicare PECOS PAC ID | 7911297510 |
|---|---|
| Medicare Enrollment ID | O20160610000890 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659720266 | NPI | - | NPPES |
| SW1177 | Medicaid | SC | |
| 1174585988 | Other | SC | INDIVIDUAL PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 4701 (South Carolina) | Primary |
| Provider Name | Wendy Fredrickson Trudeau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174585988 PECOS PAC ID: 4082645148 Enrollment ID: I20050829000324 |
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