Kaitlin Ann Fauerbach, MS, CCC-SLP

Key facts

NPI

1821211202

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

SL008665 (PA)

Practice address

134 West Point Ave
Harveys Lake, PA 18618-1861

Phone

(570) 855-5303

NPI assigned

Apr 11, 2007

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 1, 2021.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1821211202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 DEER RACK DR",
            "city": "MOUNTAIN TOP",
            "state": "PA",
            "postal_code": "187079106",
            "telephone_number": "570-855-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 WEST POINT AVE",
            "city": "HARVEYS LAKE",
            "state": "PA",
            "postal_code": "186181861",
            "telephone_number": "570-855-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUERBACH",
        "first_name": "KAITLIN",
        "middle_name": "ANN",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2021-02-01",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL008665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017779320001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Harveys Lake, PA · Speech-Language Pathologist in Pennsylvania