Carol Sue Fairless, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

Practice address

408 E Vine St
Vienna, IL 62995-1612

Phone

(618) 658-2611

Fax

(618) 658-2501

NPI assigned

Aug 17, 2006

Last updated

Sep 11, 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

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.

• Family Counseling Center

  • Community/Behavioral Health Agency
  • Vienna, IL
  • NPI 1356726707
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1619080082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 COUNTRY VLG",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "629951643",
            "telephone_number": "618-658-9295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 E VINE ST",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "629951612",
            "telephone_number": "618-658-2611",
            "fax_number": "618-658-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRLESS",
        "first_name": "CAROL",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Eblin, MSW QMHP
• Kimberly Dawn Ecker, PT
• Rachel Ann Edmonds, PT
• Amanda Endrizzi, MSPA
• Molly Kathleen English, MHP
• Family Counseling Center
• Alyssa Ferguson, BS MHP
• Caleb Fishback, BSW, MHP
• Frank E Forthman, MDIV, QMHP
• Alisha Foster, MSW

• Psychiatric/Mental Health Registered Nurse in Vienna, IL
• Providers in Vienna, IL by specialty
• Psychiatric/Mental Health Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.