Provider Demographics
NPI:1649014838
Name:FAIN, CARISSA (SLP-CF)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:FAIN
Suffix:
Gender:U
Credentials:SLP-CF
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5699 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3165
Mailing Address - Country:US
Mailing Address - Phone:303-641-5539
Mailing Address - Fax:
Practice Address - Street 1:6969 W 90TH AVE APT 933
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6463
Practice Address - Country:US
Practice Address - Phone:303-641-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health