| NPI | 1225392392 |
|---|---|
| Former Name | JESSICA FAIRBANKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60654675) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA 20826) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-02-08 |