Individual
KATHLEEN FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2101 N LAKEWOOD DR STE 226, COEUR D ALENE, ID 83814-2473
(208) 819-8321
(208) 620-2178
Mailing address
2101 N LAKEWOOD DR STE 226, COEUR D ALENE, ID 83814-2473
(208) 819-8321
(208) 620-2178
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-32949
ID
1041C0700X
Clinical Social Worker
LMSW-24840
ID
Other
Enumeration date
03/15/2011
Last updated
02/28/2023
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