Individual
JEANINE S FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CICSW
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Mailing address
2901 HUNTERS TRL, PO BOX 301, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3127-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39688300
—
WI
Enumeration date
06/30/2006
Last updated
07/08/2007
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