Provider Demographics
NPI:1982477048
Name:FRAZIER, STACEY JO (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:JO
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2667
Mailing Address - Country:US
Mailing Address - Phone:201-446-6667
Mailing Address - Fax:
Practice Address - Street 1:211 NOTTINGHAM RD
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2667
Practice Address - Country:US
Practice Address - Phone:201-446-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NJ41YS00355900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist