Provider Demographics
NPI:1659037448
Name:FRAZIER, TEDRICKA KEARRA
Entity Type:Individual
Prefix:MS
First Name:TEDRICKA
Middle Name:KEARRA
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 W HOWARD AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1952
Mailing Address - Country:US
Mailing Address - Phone:414-484-3849
Mailing Address - Fax:
Practice Address - Street 1:3340 S 22ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4806
Practice Address - Country:US
Practice Address - Phone:414-484-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker