Healthcare Provider Details

I. General information

NPI: 1073482709
Provider Name (Legal Business Name): GRACE ELIZABETH FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST
NORWALK CT
06850-3815
US

IV. Provider business mailing address

17 KENT LN
ROCKY HILL CT
06067-2910
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-4811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number708
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: