Provider Demographics
NPI:1720318900
Name:FRAZER, ANESHA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANESHA
Middle Name:
Last Name:FRAZER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 ATLANTA HIGHWAY
Mailing Address - Street 2:SUITE 101 - #12
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004
Mailing Address - Country:US
Mailing Address - Phone:404-939-1318
Mailing Address - Fax:
Practice Address - Street 1:5905 ATLANTA HIGHWAY
Practice Address - Street 2:SUITE 101 - #12
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:404-939-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2013-08-30
Deactivation Date:2010-12-03
Deactivation Code:
Reactivation Date:2013-08-30
Provider Licenses
StateLicense IDTaxonomies
GASLP007202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist