Provider Demographics
NPI:1598505398
Name:FRALEY, AMANDA NICOLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:FRALEY
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25174-0185
Mailing Address - Country:US
Mailing Address - Phone:304-222-2006
Mailing Address - Fax:
Practice Address - Street 1:301 PARK AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5355
Practice Address - Country:US
Practice Address - Phone:304-256-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist