Provider Demographics
NPI:1497257984
Name:FRAZIER, SELENA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 WEST VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:902 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL, TN
Practice Address - State:TN
Practice Address - Zip Code:37825
Practice Address - Country:US
Practice Address - Phone:423-626-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist