Provider Demographics
NPI:1265106074
Name:FRYER, MICHAELA ALLSUP (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:ALLSUP
Last Name:FRYER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 SUNDILLA CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3222
Mailing Address - Country:US
Mailing Address - Phone:256-366-7871
Mailing Address - Fax:
Practice Address - Street 1:528 SUNDILLA CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-3222
Practice Address - Country:US
Practice Address - Phone:256-366-7871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30427235Z00000X
AL5061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist