Provider Demographics
NPI:1134261324
Name:FAIRCHILD, PAULA L (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:L
Last Name:FAIRCHILD
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 1:12455 ASCOT RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64659-7215
Mailing Address - Country:US
Mailing Address - Phone:660-938-4417
Mailing Address - Fax:
Practice Address - Street 1:12455 ASCOT RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MO
Practice Address - Zip Code:64659-7215
Practice Address - Country:US
Practice Address - Phone:660-938-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist