Active NPI
Mary Beth Frazer, MCD, CCC-SLP
- Speech-Language Pathologist
- Selma, AL
National Provider Identifier
1790912079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2142
- Practice address
- 119 Mallory Dr
Selma, AL 36701-6535 - Phone
- (334) 872-6884
- NPI assigned
- Jun 15, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2142 | AL | Primary |
Addresses
Primary practice location
119 Mallory Dr
Selma, AL 36701-6535
Mailing address
119 Mallory Dr
Selma, AL 36701-6535
Phone (334) 872-6884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2142 | AL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245024000000",
"number": "1790912079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 MALLORY DR",
"city": "SELMA",
"state": "AL",
"postal_code": "367016535",
"telephone_number": "334-872-6884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 MALLORY DR",
"city": "SELMA",
"state": "AL",
"postal_code": "367016535",
"telephone_number": "334-872-6884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRAZER",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "MCD, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-15",
"last_updated": "2009-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AL",
"license": "2142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Selma, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.