Healthcare Provider Details

I. General information

NPI: 1306778758
Provider Name (Legal Business Name): HEATHER FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 BUENA VISTA WAY
CHULA VISTA CA
91910-7133
US

IV. Provider business mailing address

5316 SWARTHMORE ST
LA MESA CA
91942-1770
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-7066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: