Provider Demographics
NPI:1033421946
Name:FACQUES, CARA P (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:P
Last Name:FACQUES
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-1044
Mailing Address - Country:US
Mailing Address - Phone:603-769-4706
Mailing Address - Fax:
Practice Address - Street 1:10 NORTHERN BLVD
Practice Address - Street 2:#9B
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2336
Practice Address - Country:US
Practice Address - Phone:603-769-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist