Fafford, Andrea K-P
Fafford, Andrea K-P is an sole proprietor health care provider with primary practice located at 6501 3Rd Ave , Kenosha WI 53143-5111. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Fafford, Andrea K-P can be contacted via phone (262) 914-6540.Contact Information
Primary practice address
6501 3Rd Ave
Kenosha WI 53143-5111
Phone: (262) 914-6540
Fax: (262) 997-1061
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 7912-123 | Wisconsin |
Profile Details
| NPI number | 1255689022 |
|---|---|
| LBN Legal business name | Fafford, Andrea K-P |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 27th, 2012 |
| Last updated | Jul 13th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255689022 | NPPES |
| Wisconsin | MEDICAID | 100085186 |
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