MEDICARE: ALISON FAGANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.14252	OH

General Provider Information

NPI Number	:	1053909143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON FAGANS

Provider Business Mailing Address
First Line	:	1111 SUPERIOR AVE E STE 1800
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2500
Country	:	US
Telephone Number	:	614-448-7247
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 W 65TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-5324
Country	:	US
Telephone Number	:	216-352-4030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	08/01/2022

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Directions to “ ALISON FAGANS ” Practice Location

Language	Start Address	Practice Location

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