Provider Demographics
NPI:1598103574
Name:MAGANN FAIVRE, RACHEL ASHLEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ASHLEY
Last Name:MAGANN FAIVRE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ASHLEY
Other - Last Name:MAGANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2637 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2231
Mailing Address - Country:US
Mailing Address - Phone:815-618-8006
Mailing Address - Fax:
Practice Address - Street 1:2637 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2231
Practice Address - Country:US
Practice Address - Phone:815-618-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9102231H00000X
OK4303231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640000738Medicare PIN