Healthcare Provider Details

I. General information

NPI: 1205627460
Provider Name (Legal Business Name): JORDAN MAE FRAZEE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLOIS BLVD
WINSTON SALEM NC
27103-1522
US

IV. Provider business mailing address

4988 OLD TOWNE VILLAGE CIR
PFAFFTOWN NC
27040-9806
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3361
  • Fax:
Mailing address:
  • Phone: 765-580-2853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: