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General NPI Number Information
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NPI Number | 1295970259
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Entity Type | Individual
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Provider Name | JOY MARIE FAIRBANKS PHD
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Gender | Female
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 7770 DELL RD STE 120
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City | CHANHASSEN
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State | MN
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Zip | 55317-9316
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Country | US
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Telephone | 952-955-4714
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Fax | 952-955-6213
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Provider Business Mailing Address
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Address Line | 7770 DELL RD STE 120
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City | CHANHASSEN
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State | MN
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Zip | 55317-9316
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Country | US
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Telephone | 952-955-4714
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Fax | 952-955-6213
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP5302
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License Number State | MN
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