Provider Demographics
NPI:1902162910
Name:FAVRUZZO, BARBARA (MED CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:FAVRUZZO
Suffix:
Gender:F
Credentials:MED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N TRYON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2180
Mailing Address - Country:US
Mailing Address - Phone:336-392-7375
Mailing Address - Fax:
Practice Address - Street 1:127 N TRYON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2180
Practice Address - Country:US
Practice Address - Phone:336-392-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist