Provider Demographics
NPI:1932620549
Name:FAIRBANKS, KRISTEN (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4527
Mailing Address - Country:US
Mailing Address - Phone:425-387-8531
Mailing Address - Fax:
Practice Address - Street 1:2315 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-4527
Practice Address - Country:US
Practice Address - Phone:970-773-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA607459091041C0700X
WA610939891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical