Provider Demographics
NPI:1467191064
Name:FAUVER, DESIREE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:FAUVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 COUNTY ROAD 305B
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-3049
Mailing Address - Country:US
Mailing Address - Phone:817-988-9238
Mailing Address - Fax:
Practice Address - Street 1:6724 COUNTY ROAD 305B
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-3049
Practice Address - Country:US
Practice Address - Phone:817-988-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist