Individual
KIMBERLY FAIRCHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5514
Mailing address
1472 16TH AVE, ARKDALE, WI 54613-9624
(920) 889-9388
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7129-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100043623
—
WI
05
—
K401235342
—
WI
Enumeration date
04/07/2015
Last updated
06/23/2025
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