Provider Demographics
NPI:1285147876
Name:FRAZIER, KELSEY RAE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:RAE
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 NE 139TH STREET
Mailing Address - Street 2:MEDICAL OFFICE BUILDING A, SUITE #200
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2742
Mailing Address - Country:US
Mailing Address - Phone:360-487-1777
Mailing Address - Fax:
Practice Address - Street 1:2121 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2316
Practice Address - Country:US
Practice Address - Phone:360-487-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60773129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1285147876Medicaid