Fairbanks, Joseph
Fairbanks, Joseph is an individual health care provider with primary practice located at 146 E Geneva Sq , Lake Geneva WI 53147-9694. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Fairbanks, Joseph can be contacted via phone (877) 666-7223.Contact Information
Primary practice address
146 E Geneva Sq
Lake Geneva WI 53147-9694
Phone: (877) 666-7223
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2954-125 | Wisconsin |
Profile Details
| NPI number | 1073507067 |
|---|---|
| LBN Legal business name | Fairbanks, Joseph |
| Credentials | LPC, CEAP, NCC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 6th, 2005 |
| Last updated | Jan 9th, 2024 - about 11 months 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 | 1073507067 | NPPES |
| Wisconsin | MEDICAID | 43561200 | |
| Wisconsin | Other | 2954-125 |
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