Fair, Jeanine S

Fair, Jeanine S is an individual health care provider with primary practice located at 2901 Hunters Trl , Portage WI 53901-3403. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Fair, Jeanine S can be contacted via phone (608) 742-5518.

Contact Information

Primary practice address
2901 Hunters Trl Portage WI 53901-3403
Phone: (608) 742-5518
Fax: (608) 742-4087
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 3127-123 Wisconsin

Profile Details

NPI number 1174551774
LBN Legal business name Fair, Jeanine S
Credentials MSW, CICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2006
Last updated Jul 8th, 2007 - about 19 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174551774 NPPES
Wisconsin MEDICAID 39688300

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