MEDICARE: KAITLIN ANN FAUERBACH MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL008665	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821211202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN ANN FAUERBACH MS, CCC-SLP

Provider Business Mailing Address
First Line	:	710 DEER RACK DR
Second Line	:
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-9106
Country	:	US
Telephone Number	:	570-855-5303
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 WEST POINT AVE
Second Line	:
City	:	HARVEYS LAKE
State	:	PA
Zip	:	18618-1861
Country	:	US
Telephone Number	:	570-855-5303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	02/01/2021

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Directions to “ KAITLIN ANN FAUERBACH MS, CCC-SLP” Practice Location

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