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NPI Code Detail

MEDICARE: ALEXIS DENISE FRASER MA, TLLP

MEDICARE: ALEXIS DENISE FRASER MA, TLLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6362009692MI

General Provider Information

NPI Number : 1205549151
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS DENISE FRASER MA, TLLP
Provider Business Mailing Address
First Line : 278 WOODRIDGE DRIVE
Second Line :
City : TECUMSEH
State : ONTARIO
Zip : N8N 3A4
Country : CA
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 632 N MILL ST
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-1422
Country : US
Telephone Number : 734-335-0330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2023
Last Update Date : 01/05/2023

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