Provider Demographics
NPI:1417117813
Name:FRASER, KERRI L (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:L
Last Name:FRASER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15165 ESTES RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9202
Mailing Address - Country:US
Mailing Address - Phone:360-755-0711
Mailing Address - Fax:
Practice Address - Street 1:1036 E VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1623
Practice Address - Country:US
Practice Address - Phone:360-755-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist