Provider Demographics
NPI:1487468104
Name:FRYE, JOSILENA MARIE (M ED, EDS)
Entity type:Individual
Prefix:
First Name:JOSILENA
Middle Name:MARIE
Last Name:FRYE
Suffix:
Gender:F
Credentials:M ED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5773 ENRAMADA DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:CA
Mailing Address - Zip Code:95329-9734
Mailing Address - Country:US
Mailing Address - Phone:209-890-9696
Mailing Address - Fax:
Practice Address - Street 1:5773 ENRAMADA DR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:CA
Practice Address - Zip Code:95329-9734
Practice Address - Country:US
Practice Address - Phone:209-890-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician