MEDICARE: KELSI ANNE FRASER

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	SLPL4911	AZ
2	2355S0801X	Speech-Language Assistant	37096	TX

General Provider Information

NPI Number	:	1700994993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSI ANNE FRASER

Provider Business Mailing Address
First Line	:	25314 DONAHUE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-2471
Country	:	US
Telephone Number	:	602-663-1605
Fax Number	:	602-663-1605

Provider Business Practice Location Address
First Line	:	13333 BLANCO RD STE 302
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7756
Country	:	US
Telephone Number	:	210-248-0805
Fax Number	:

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	08/21/2024

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Directions to “ KELSI ANNE FRASER ” Practice Location

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