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General NPI Number Information
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NPI Number | 1629327382
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Entity Type | Individual
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Provider Name | KRISTEN FAITH FAHNSTROM M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/09/2012
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 2 WESTBROOK CORPORATE CTR STE 800
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City | WESTCHESTER
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State | IL
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Zip | 60154-5702
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Country | US
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Telephone | 800-714-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 661 CAMBRIDGE WAY
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1058
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Country | US
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Telephone |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146011275
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License Number State | IL
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