Provider Demographics
NPI:1952702912
Name:FROST, SUSAN BEA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BEA
Last Name:FROST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BEA
Other - Last Name:FIALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10010 EDMONDSON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8300
Mailing Address - Country:US
Mailing Address - Phone:573-578-7787
Mailing Address - Fax:
Practice Address - Street 1:10010 EDMONDSON HILLS DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8300
Practice Address - Country:US
Practice Address - Phone:573-578-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002874251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)