Provider Demographics
NPI:1821348285
Name:FAHY, KRISTINA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:A
Last Name:FAHY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W. BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614
Mailing Address - Country:US
Mailing Address - Phone:585-262-8100
Mailing Address - Fax:585-334-2858
Practice Address - Street 1:131 W. BROAD ST.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614
Practice Address - Country:US
Practice Address - Phone:585-262-8100
Practice Address - Fax:585-334-2858
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013826-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist