Provider Demographics
NPI:1770833220
Name:FRAZIER, LESLIE RICHELLE (MS, CCC-SLP, MED)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RICHELLE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MS, CCC-SLP, MED
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:RICHELLE
Other - Last Name:SKANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 4TH ST NE
Mailing Address - Street 2:AUBURN STUDENT SPECIAL SERVICES ANNEX
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5020
Mailing Address - Country:US
Mailing Address - Phone:253-931-4927
Mailing Address - Fax:253-931-4742
Practice Address - Street 1:502 4TH ST NE
Practice Address - Street 2:AUBURN STUDENT SPECIAL SERVICES ANNEX
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5020
Practice Address - Country:US
Practice Address - Phone:253-931-4927
Practice Address - Fax:253-931-4742
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAESA 412822R235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01114846OtherASHA CERTIFICATE OF CLINICAL COMPETENCE
WA412822ROtherEDUCATIONAL STAFF ASSOCIATE CERTIFICATE