Kimberly Fairchild, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7129-125 Issued in WI

Practice address

400 S Townline Rd
Wautoma, WI 54982-6922

Phone

(920) 787-5514

NPI assigned

Apr 7, 2015

Last updated

Jun 23, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

La Clinica de Los Campesinos, IncGroup PAC ID 8729996574, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Clinica de Los Campesinos, Inc

  dba Noble Community Clinics

  • Federally Qualified Health Center (FQHC)
  • Stevens Point, WI
  • NPI 1790786929
  Medicare reassignment Care Compare group NPD
• La Clinica de Los Campesinos, Inc

  • Pharmacy
  • Wautoma, WI
  • NPI 1174322846
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1225424286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1472 16TH AVE",
            "city": "ARKDALE",
            "state": "WI",
            "postal_code": "546139624",
            "telephone_number": "920-889-9388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S TOWNLINE RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549826922",
            "telephone_number": "920-787-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRCHILD",
        "first_name": "KIMBERLY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-07",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "7129-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100043623",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "K401235342",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kellen Dorff, PHARMD
• Katrina L Dorow Stevens, MA
• Paige Dorsey, APNP
• Veronica Eckstein, CSAC
• Lori Dale Erdman
• Emily Fenton, DPT
• Forefront Dermatology SC
• Forefront Dermatology, S.C.
• Eric Foss, RPH
• Joan L. Fox, DDS

• Mental Health Counselor in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.