Individual
MRS. CARLENE MARIE FAIRBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
8330 E OSBORN RD, SCOTTSDALE, AZ 85251-5904
(480) 484-2800
Mailing address
901 E MOUNTAIN VISTA DR, PHOENIX, AZ 85048-1918
(480) 460-3906
(480) 460-3290
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP0398
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP0398
AZ DEPT. HEALTH SERVICE
AZ
Enumeration date
02/12/2007
Last updated
07/09/2007
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