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General NPI Number Information
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NPI Number | 1427779446
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Entity Type | Individual
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Provider Name | ADRIENNE FAHY
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Gender | Female
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 9057 S HOYNE AVE
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City | CHICAGO
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State | IL
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Zip | 60643-6405
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Country | US
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Telephone | 773-610-4664
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Fax |
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Provider Business Mailing Address
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Address Line | 3426 W 116TH PL
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City | CHICAGO
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State | IL
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Zip | 60655-3631
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Country | US
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Telephone | 773-899-1589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.006652
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License Number State | IL
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