MEDICARE: ALLISON FAIRBROTHER

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	SZ6573	FL
2	235Z00000X	Speech-Language Pathologist	SA13755	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699198382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON FAIRBROTHER

Provider Business Mailing Address
First Line	:	16758 GOLFVIEW DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-1811
Country	:	US
Telephone Number	:	954-736-7464
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 N UNIVERSITY DR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2230
Country	:	US
Telephone Number	:	954-736-7464
Fax Number	:

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

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	03/22/2024

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Directions to “ ALLISON FAIRBROTHER ” Practice Location

Language	Start Address	Practice Location

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