Provider Demographics
NPI:1619039377
Name:FRAZER, MARIE THERESE-BIRNBAUM (AUD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESE-BIRNBAUM
Last Name:FRAZER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:THERESE
Other - Last Name:BIRNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:408-510-0088
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:408-510-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2540231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist