Healthcare Provider Details

I. General information

NPI: 1386559516
Provider Name (Legal Business Name): SCOTT FRAZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11317 N BOBOLINK LN
MEQUON WI
53092-3004
US

IV. Provider business mailing address

11317 N BOBOLINK LN
MEQUON WI
53092-3004
US

V. Phone/Fax

Practice location:
  • Phone: 323-963-3236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: