Individual
LORI R FAIRBAIRN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
1177 QUAIL CT STE 101, PEWAUKEE, WI 53072-3768
(262) 696-9809
Mailing address
1177 QUAIL CT STE 101, PEWAUKEE, WI 53072-3768
(262) 696-9809
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
684-228
WI
Other
Enumeration date
11/27/2021
Last updated
11/27/2021
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