Provider Demographics
NPI:1033361209
Name:FAIRCHILD, PATRICIA K (MA, CCC-SP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:K
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 TREETOPS TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-4336
Mailing Address - Country:US
Mailing Address - Phone:845-386-3999
Mailing Address - Fax:
Practice Address - Street 1:9 CEDAR DR
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1004
Practice Address - Country:US
Practice Address - Phone:845-876-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-19
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006626-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist