Individual
MRS. MALINDA RAE FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1898 FORT RD, SHERIDAN, WY 82801-8320
(307) 675-3938
Mailing address
1205 LAUREL CT, SHERIDAN, WY 82801-6707
(307) 761-2442
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 723
WY
Other
Enumeration date
03/15/2011
Last updated
03/15/2011
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