Healthcare Provider Details

I. General information

NPI: 1982510848
Provider Name (Legal Business Name): JESSICA LYNN FAIRBARN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 E WOODSBORO AVE
ANAHEIM CA
92807-2441
US

IV. Provider business mailing address

2666 ORANGE AVE APT B
COSTA MESA CA
92627-4694
US

V. Phone/Fax

Practice location:
  • Phone: 714-986-7040
  • Fax:
Mailing address:
  • Phone: 949-887-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: