Individual
ALLISON FAYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6776 LAKE DR STE 220, LINO LAKES, MN 55014-1192
(651) 784-7007
Mailing address
6776 LAKE DR STE 220, LINO LAKES, MN 55014-1192
(651) 784-7007
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
073302
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851780423
—
MN
Enumeration date
01/20/2015
Last updated
03/30/2018
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