Individual
KALEY SUZANNE FAIRBAIRN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
550 CASCADE WEST PKWY SE, GRAND RAPIDS, MI 49546-2137
(616) 930-4123
Mailing address
1960 RUPERT ST NE, GRAND RAPIDS, MI 49525-2861
(616) 540-6010
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801098978
MI
104100000X
Social Worker
Primary
6801108273
MI
Other
Enumeration date
03/12/2017
Last updated
12/14/2020
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