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General NPI Number Information
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NPI Number | 1285933358
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Entity Type | Individual
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Provider Name | KATHLEEN FAIRBANKS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 2101 N LAKEWOOD DR STE 226
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2473
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Country | US
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Telephone | 208-819-8321
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Fax | 208-620-2178
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Provider Business Mailing Address
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Address Line | 2101 N LAKEWOOD DR STE 226
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2473
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Country | US
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Telephone | 208-819-8321
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Fax | 208-620-2178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-32949
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW-24840
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License Number State | ID
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