Carol Sue Fairless, RN
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Vienna, IL
NPI 1619080082 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1619080082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- Practice address
- 408 E Vine St
Vienna, IL 62995-1612 - Phone
- (618) 658-2611
- Fax
- (618) 658-2501
- NPI assigned
- Aug 17, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041-207554 | IL | MD | Psychiatric/Mental Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | IL | ||
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | IL | Yes |
Addresses
Primary practice location
408 E Vine St
Vienna, IL 62995-1612
Mailing address
303 Country VLG
Vienna, IL 62995-1643
Phone (618) 658-9295
Other providers in Vienna, IL
- Kimberly Dawn Ecker
- Rachel Ann Edmonds
- Amanda Endrizzi
- Molly Kathleen English
- Emily Enyart
- Family Counseling Center
- Alyssa Ferguson
- Caleb Fishback
- Frank E Forthman
- Alisha Foster
All providers in Vienna, IL · Psychiatric/Mental Health Registered Nurse in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.