Provider Demographics
NPI:1275018665
Name:FAIRBANKS, MEGHAN HENNESSY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:HENNESSY
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:KAY
Other - Last Name:HENNESSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8027 OAK BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3410
Mailing Address - Country:US
Mailing Address - Phone:716-515-8024
Mailing Address - Fax:
Practice Address - Street 1:7001A LOISDALE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150
Practice Address - Country:US
Practice Address - Phone:703-971-0602
Practice Address - Fax:949-863-6813
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist