Provider Demographics
NPI:1891672374
Name:FAGIN, CHARLIE
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:FAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:FAGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 NE HAMPE WAY
Mailing Address - Street 2:SUITE C4-1 BOX 8
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0008
Mailing Address - Country:US
Mailing Address - Phone:360-748-3384
Mailing Address - Fax:
Practice Address - Street 1:151 NE HAMPE WAY
Practice Address - Street 2:SUITE C4-1 BOX 8
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-0008
Practice Address - Country:US
Practice Address - Phone:360-748-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant