Provider Demographics
NPI:1376720797
Name:FRALEY, BETH ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:FRALEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 W CLARE CT
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2723
Mailing Address - Country:US
Mailing Address - Phone:630-422-7116
Mailing Address - Fax:
Practice Address - Street 1:494 W CLARE CT
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-2723
Practice Address - Country:US
Practice Address - Phone:630-422-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist