Healthcare Provider Details

I. General information

NPI: 1053909143
Provider Name (Legal Business Name): ALISON FAGANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 W 65TH ST
CLEVELAND OH
44102-5324
US

IV. Provider business mailing address

1111 SUPERIOR AVE E STE 1800
CLEVELAND OH
44114-2500
US

V. Phone/Fax

Practice location:
  • Phone: 216-352-4030
  • Fax:
Mailing address:
  • Phone: 614-448-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.14252
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: