Provider Demographics
NPI:1578054771
Name:CRAIG, FALLON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MEENANS COVE ROAD
Mailing Address - Street 2:
Mailing Address - City:QUISPAMSIS
Mailing Address - State:NEW BRUNSWICK
Mailing Address - Zip Code:E2E 1M7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 MEENANS COVE ROAD
Practice Address - Street 2:
Practice Address - City:QUISPAMSIS
Practice Address - State:NEW BRUNSWICK
Practice Address - Zip Code:E2E 1M7
Practice Address - Country:CA
Practice Address - Phone:506-333-4632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist