Provider Demographics
NPI:1154022945
Name:FRALEY, LYNDI ASHTON (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNDI
Middle Name:ASHTON
Last Name:FRALEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LYNDI
Other - Middle Name:ASHTON
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 SOUTH CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HOLCOMB
Mailing Address - State:MO
Mailing Address - Zip Code:63852
Mailing Address - Country:US
Mailing Address - Phone:573-792-3113
Mailing Address - Fax:
Practice Address - Street 1:102 SOUTH CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOLCOMB
Practice Address - State:MO
Practice Address - Zip Code:63852
Practice Address - Country:US
Practice Address - Phone:573-792-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist