Provider Demographics
NPI:1457039356
Name:FAHLMAN, MARY (CFY-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FAHLMAN
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 FOSTER LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-3318
Mailing Address - Country:US
Mailing Address - Phone:406-969-1795
Mailing Address - Fax:406-969-1796
Practice Address - Street 1:245 FOSTER LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-3318
Practice Address - Country:US
Practice Address - Phone:406-969-1795
Practice Address - Fax:406-969-1796
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist