Individual
MISS CHARLY RENAE FAUSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., SLP-CF
Contact information
Practice address
2400 VETERANS MEMORIAL DR, CAPE GIRARDEAU, MO 63701-9620
(573) 290-5870
Mailing address
PO BOX 383, WARSAW, MO 65355-0383
(417) 354-0225
(417) 354-0325
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2013029960
MO
Other
Enumeration date
09/26/2013
Last updated
09/26/2013
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