Individual
MRS. AMY ELIZABETH FAHNESTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 HENRY ST, ALTON, IL 62002-4446
(618) 463-2077
Mailing address
2400 HENRY ST, ALTON, IL 62002-4446
(618) 463-2077
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146006061
IL
Other
Enumeration date
08/18/2017
Last updated
08/18/2017
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