Individual
KELLYE WINBUSH FAIRLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
680 N LAKE SHORE DR STE 110-1750, CHICAGO, IL 60611-4546
(312) 523-0728
(312) 683-9416
Mailing address
6438 S WOODLAWN AVE APT 2S, CHICAGO, IL 60637-7343
(312) 523-0728
(312) 683-9416
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HSD0V700
—
IL
Enumeration date
10/19/2009
Last updated
01/27/2026
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