Provider Demographics
NPI:1205004322
Name:FRALLIC, KAY (MA, CCC-A)
Entity Type:Individual
Prefix:MISS
First Name:KAY
Middle Name:
Last Name:FRALLIC
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S UNION AVE BLDG B
Mailing Address - Street 2:SUITE B-2001
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-272-3090
Mailing Address - Fax:253-627-1415
Practice Address - Street 1:1901 S UNION AVE BLDG B
Practice Address - Street 2:SUITE B-2001
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-272-3090
Practice Address - Fax:253-627-1415
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002309237600000X
OR22204237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031085Medicaid
WAG8920772Medicare PIN