Provider Demographics
NPI:1134866692
Name:FAGERSTROM, ANNIKA MARIE (SLP)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:MARIE
Last Name:FAGERSTROM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6952 SUTER RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1205
Mailing Address - Country:US
Mailing Address - Phone:484-538-8657
Mailing Address - Fax:
Practice Address - Street 1:1627 PENN AVE APT 705
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-4353
Practice Address - Country:US
Practice Address - Phone:484-538-8657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist