Individual
LISA FAZALARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-A
Contact information
Practice address
1 MEDICAL CENTER DRIVE, CLARKSBURG, WV 26301
(304) 623-3461
Mailing address
19 BENTON LN, FAIRMONT, WV 26554-8365
(304) 623-3461
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A-0111
WV
Other
Enumeration date
06/30/2006
Last updated
07/08/2007
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