MEDICARE: MS. LESLIE ANN FRASER MS,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	SA0002406	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA0002406	OTHER	FL	FL STATE SLP LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730184011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE ANN FRASER MS,CCC-SLP

Provider Business Mailing Address
First Line	:	10666 NE 11TH CT
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2123
Country	:	US
Telephone Number	:	305-899-8892
Fax Number	:	305-899-1137

Provider Business Practice Location Address
First Line	:	12340 NE 6TH CT
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-5518
Country	:	US
Telephone Number	:	305-981-4000
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/09/2007

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