Individual
KAITLIN ANN FAUERBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
134 WEST POINT AVE, HARVEYS LAKE, PA 18618-1861
(570) 855-5303
Mailing address
710 DEER RACK DR, MOUNTAIN TOP, PA 18707-9106
(570) 855-5303
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL008665
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017779320001
—
PA
Enumeration date
04/11/2007
Last updated
02/01/2021
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