MEDICARE: KATHERINE ROSE FAIRWEATHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	ASW131234	CA

General Provider Information

NPI Number	:	1831701937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ROSE FAIRWEATHER

Provider Business Mailing Address
First Line	:	265 SAN JACINTO RIVER RD STE 107
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4400
Country	:	US
Telephone Number	:	951-754-9084
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 SAN JACINTO RIVER RD STE 107
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4400
Country	:	US
Telephone Number	:	951-754-9084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	02/11/2026

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Directions to “ KATHERINE ROSE FAIRWEATHER ” Practice Location

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