Provider Demographics
NPI:1336524834
Name:FRAZIER, STACIE
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:
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 1:17300 OZARK AVE
Mailing Address - Street 2:NORTH BLDG.
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2693
Mailing Address - Country:US
Mailing Address - Phone:800-597-7798
Mailing Address - Fax:708-429-8246
Practice Address - Street 1:17300 OZARK AVE
Practice Address - Street 2:NORTH BLDG.
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2693
Practice Address - Country:US
Practice Address - Phone:800-597-7798
Practice Address - Fax:708-429-8246
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist