Provider Demographics
NPI:1447916549
Name:FRALEY, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:FRALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E FREEDOM WAY UNIT 415
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-3456
Mailing Address - Country:US
Mailing Address - Phone:406-871-1321
Mailing Address - Fax:
Practice Address - Street 1:120 E FREEDOM WAY UNIT 415
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-3456
Practice Address - Country:US
Practice Address - Phone:406-871-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist