Jacqueline Fairbanks, CCC MS/L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146012836 Issued in IL

Practice address

40 E Dundee Rd
Barrington, IL 60010-5227

Phone

(224) 770-4339

NPI assigned

Nov 15, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Jacqueline Faber Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1750047700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22382 N RICHMOND CT",
            "city": "KILDEER",
            "state": "IL",
            "postal_code": "600477948",
            "telephone_number": "815-742-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 E DUNDEE RD",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600105227",
            "telephone_number": "224-770-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "JACQUELINE",
        "name_prefix": "Mrs.",
        "credential": "CCC MS/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-15",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146012836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FABER",
            "prefix": "MISS",
            "credential": "CCC MS/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Barrington, IL
• Providers in Barrington, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.