Individual
JACQLIN FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
132 S WATER ST, SUITE 604, DECATUR, IL 62523-1332
(217) 423-6199
(217) 233-7028
Mailing address
132 S WATER ST, SUITE 604, DECATUR, IL 62523-1332
(217) 423-6199
(217) 233-7028
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/17/2017
Last updated
02/17/2017
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