Provider Demographics
NPI:1013572478
Name:FRAZIER, STACY MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 HANNA LN
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:OH
Mailing Address - Zip Code:45647-9755
Mailing Address - Country:US
Mailing Address - Phone:740-253-8948
Mailing Address - Fax:
Practice Address - Street 1:167 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3107
Practice Address - Country:US
Practice Address - Phone:740-773-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP09439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist