Individual
MRS. FAWN FANDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, PLPC
Contact information
Practice address
1310 BROWNSWITCH RD STE D, SLIDELL, LA 70461-1611
(985) 774-4643
(985) 288-5405
Mailing address
14400 LAKE TAHOE DR, COVINGTON, LA 70433-6951
(985) 774-4643
(985) 288-5405
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
7417
LA
Other
Enumeration date
06/04/2018
Last updated
06/04/2018
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