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NPI Code Detail

MEDICARE: MS. SUSAN FRALICK

MEDICARE: MS. SUSAN FRALICK
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
1101YM0800XMental Health CounselorE0000555OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000004356OTHEROHANTHEM
2197091000OTHEROHMAGELLAN

General Provider Information

NPI Number : 1548251325
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN FRALICK
Provider Business Mailing Address
First Line : 1 CHILDRENS PLZ
Second Line :
City : DAYTON
State : OH
Zip : 45404-1873
Country : US
Telephone Number : 937-641-3000
Fax Number :
Provider Business Practice Location Address
First Line : 1 CHILDRENS PLZ
Second Line :
City : DAYTON
State : OH
Zip : 45404-1873
Country : US
Telephone Number : 937-641-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 02/06/2020

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