Provider Demographics
NPI:1962732487
Name:FRY, SHEILA M (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:M
Last Name:FRY
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 1:375 S RANDOLPH AVE
Mailing Address - Street 2:#207
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5750
Mailing Address - Country:US
Mailing Address - Phone:714-222-3262
Mailing Address - Fax:
Practice Address - Street 1:1301 W PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3808
Practice Address - Country:US
Practice Address - Phone:855-901-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 16299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist