Provider Demographics
NPI:1427361831
Name:GREEN FAGER, MELANIE E (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:E
Last Name:GREEN FAGER
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 BLUFF ST
Mailing Address - Street 2:APT 201
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1678
Mailing Address - Country:US
Mailing Address - Phone:815-871-1799
Mailing Address - Fax:
Practice Address - Street 1:750 BLUFF ST
Practice Address - Street 2:APT 201
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1678
Practice Address - Country:US
Practice Address - Phone:815-871-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist