Individual
EMILY ANN FAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4905 18TH AVE UPPR, KENOSHA, WI 53140-3295
(262) 745-9266
Mailing address
4905 18TH AVE UPPR, KENOSHA, WI 53140-3295
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-45169
IL
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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