Provider Demographics
NPI:1689802043
Name:FAIRCHILD, ALYSSA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARIE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26622 COOK FIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2139
Mailing Address - Country:US
Mailing Address - Phone:281-766-3831
Mailing Address - Fax:844-615-5271
Practice Address - Street 1:26622 COOK FIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2139
Practice Address - Country:US
Practice Address - Phone:281-460-6299
Practice Address - Fax:844-615-5271
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist