MEDICARE: MARLA FRAZIER MCDANIEL MA, CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	0000003869	TN

General Provider Information

NPI Number	:	1508342858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA FRAZIER MCDANIEL MA, CCC-SLP

Provider Business Mailing Address
First Line	:	2316 CORRAL RD
Second Line	:
City	:	SIGNAL MOUNTAIN
State	:	TN
Zip	:	37377-1308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 CORRAL RD
Second Line	:
City	:	SIGNAL MOUNTAIN
State	:	TN
Zip	:	37377-1308
Country	:	US
Telephone Number	:	423-886-6084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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