Provider Demographics
NPI:1215284658
Name:FAEHNLE, ANNETTE MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MICHELLE
Last Name:FAEHNLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 MITSCHER DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3718 N ROOSEVELT BLVD
Practice Address - Street 2:STE F
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4533
Practice Address - Country:US
Practice Address - Phone:305-247-8227
Practice Address - Fax:305-247-8228
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist