Individual
CLEA MARIE FAIRAIZL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
Mailing address
3001 WARRIOR LN, POPLAR BLUFF, MO 63901-8685
(573) 686-1200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2017011361
MO
Other
Enumeration date
11/09/2007
Last updated
03/17/2022
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