Provider Demographics
NPI:1992243067
Name:FAHNER, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:FAHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-1241
Mailing Address - Country:US
Mailing Address - Phone:615-443-4445
Mailing Address - Fax:
Practice Address - Street 1:163 BUSINESS PARK DR
Practice Address - Street 2:SUITE 11
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-1241
Practice Address - Country:US
Practice Address - Phone:615-443-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist