Healthcare Provider Details

I. General information

NPI: 1790297927
Provider Name (Legal Business Name): COURTNEY FAERBER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 W 133RD ST
LEAWOOD KS
66209-3347
US

IV. Provider business mailing address

3715 W 133RD ST
LEAWOOD KS
66209-3347
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-4223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: