Provider Demographics
NPI:1013040617
Name:FRAZIER, MONIQUE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:R
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E 1260 N
Mailing Address - Street 2:PO BOX 6244
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7501
Mailing Address - Country:US
Mailing Address - Phone:435-750-6300
Mailing Address - Fax:435-753-8995
Practice Address - Street 1:246 E 1260 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7501
Practice Address - Country:US
Practice Address - Phone:435-750-6300
Practice Address - Fax:435-753-8995
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2797447-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT62617OtherPEHP
UT825140OtherDMBA
UT107008963103OtherIHC
UT27974472500001OtherREGENCE BXBS
UTUT01753Medicare ID - Type UnspecifiedMEDICARE SUBMITTER ID