Kelly J Fairchild, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801058552 Issued in MI

Practice address

3351 Eagle Run Dr NE
Ste C
Grand Rapids, MI 49525-7070

Phone

(616) 365-8920

Fax

(616) 365-8971

NPI assigned

Feb 16, 2011

Last updated

Feb 16, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Behavioral Resources and Institute for Neuropsychological Services

  dba Brains

  • Physical Therapist
  • Grand Rapids, MI
  • NPI 1467724518
  NPD (past)

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

{
    "created_epoch": "1297814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297814400000",
    "number": "1447557111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 EAGLE RUN DR NE",
            "address_2": "STE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257070",
            "telephone_number": "616-365-8920",
            "fax_number": "616-365-8971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 EAGLE RUN DR NE",
            "address_2": "STE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257070",
            "telephone_number": "616-365-8920",
            "fax_number": "616-365-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRCHILD",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-16",
        "last_updated": "2011-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801058552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Fairbanks, OTR/L
• Ethan Cross Fairbanks, MD
• Haleigh Fairbanks, LLMSW
• David Fairchild II
• Hannah Fairchild, MD
• Ebonie Fairfax
• Faith Palliative Care
• Faith&Grace Enterprise LLC (Faith Haven Adult Foster Care Home)
• Mohamed Ali Fakherddine, PHARM D CANDIDATE
• Laith Samir Fakhouri, MD

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.