Kaley Suzanne Fairbairn, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801108273 Issued in MI

Practice address

550 Cascade West Pkwy SE
Grand Rapids, MI 49546-2137

Phone

(616) 930-4123

NPI assigned

Mar 12, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

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 and National Provider Directory roles.

• Kaley Fairbairn LLC

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1033870829

  MI

  Medicare reassignment NPD Authorized official
• D a Blodgett-St Johns

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1801929435
  NPD (past)
• D.a. Blodgett - St. John'S

  • Community/Behavioral Health Agency
  • Grand Rapids, MI
  • NPI 1861701229
  NPD (past)
• David W Hamilton PSYD PLLC

  • Psychologist
  • Grand Rapids, MI
  • NPI 1396030466
  NPD (past)

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

{
    "created_epoch": "1489276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1396286258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 RUPERT ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495252861",
            "telephone_number": "616-540-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 CASCADE WEST PKWY SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462137",
            "telephone_number": "616-930-4123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Leonard St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495031138",
            "country_code": "US",
            "telephone_number": "616-451-2021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAIRBAIRN",
        "first_name": "KALEY",
        "middle_name": "SUZANNE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-12",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801098978",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801108273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James B Fahner, MD
• Sarah Elizabeth Fahnhorst, D.O.
• Alicia V Fahr, PH.D. LPC
• Daniel R Fain, MD
• Ayana Fair, LLMSW
• Amanda Fairbanks, OTR/L
• Ethan Cross Fairbanks, MD
• Haleigh Fairbanks, LLMSW
• David Fairchild II
• Hannah Fairchild, MD

• All providers in Grand Rapids, MI
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.