Provider Demographics
NPI:1427211333
Name:FRATECELLI, CARRIE LEONHART (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEONHART
Last Name:FRATECELLI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:LEONHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:800 OAKBROOK PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-8476
Mailing Address - Country:US
Mailing Address - Phone:785-274-9334
Mailing Address - Fax:
Practice Address - Street 1:800 OAKBROOK PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-8476
Practice Address - Country:US
Practice Address - Phone:785-274-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KS3147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200564800BMedicaid