Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2797447-2501 | UT |
Y | 103TC0700X | Clinical Psychologist | 2797447-2501 | UT |
NPI | 1013040617 |
---|---|
Provider Name | Dr. Monique R Frazier |
First Address | Logan, UT 84341-7501 |
Second Address | Logan, UT 84341-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107008963103 | IHC (01) | UT |
27974472500001 | REGENCE BXBS (01) | UT |
62617 | PEHP (01) | UT |
825140 | DMBA (01) | UT |