Provider Demographics
NPI:1821428434
Name:FRAULO, MARLENE (MA C,C,C,-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:
Last Name:FRAULO
Suffix:
Gender:F
Credentials:MA C,C,C,-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BROADALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3241
Mailing Address - Country:US
Mailing Address - Phone:201-289-7039
Mailing Address - Fax:973-859-0958
Practice Address - Street 1:58 BROADALE AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3241
Practice Address - Country:US
Practice Address - Phone:201-289-7039
Practice Address - Fax:973-859-0958
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00025300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist