| Kaley Fairbairn Llc | |
|
1960 Rupert St Ne Grand Rapids MI 49525-2861 | |
| (616) 540-6010 | |
| Not Available |
| Full Name | Kaley Fairbairn Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1960 Rupert St Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Kaley Fairbairn (OWNER) |
| Authorized Official Contact | 6165406010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaley Fairbairn Llc 1960 Rupert St Ne Grand Rapids MI 49525-2861 Ph: (616) 540-6010 | Kaley Fairbairn Llc 1960 Rupert St Ne Grand Rapids MI 49525-2861 Ph: (616) 540-6010 |
| NPI Number | 1033870829 |
|---|---|
| Provider Enumeration Date | 01/04/2022 |
| Last Update Date | 01/04/2022 |
| Certification Date | 01/04/2022 |
| Medicare PECOS PAC ID | 6800262379 |
|---|---|
| Medicare Enrollment ID | O20221025001869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033870829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kaley Suzanne Fairbairn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396286258 PECOS PAC ID: 9133530306 Enrollment ID: I20201118002327 |
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