Provider Demographics
NPI:1225422991
Name:FAASSE, TODD M
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:FAASSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S MAIN ST
Mailing Address - Street 2:STE 10
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4615
Mailing Address - Country:US
Mailing Address - Phone:928-634-5122
Mailing Address - Fax:
Practice Address - Street 1:703 S MAIN ST
Practice Address - Street 2:STE 10
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4615
Practice Address - Country:US
Practice Address - Phone:928-634-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist