Healthcare Provider Details

I. General information

NPI: 1134283666
Provider Name (Legal Business Name): DONNA MARIE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LIMIT ST
LEAVENWORTH KS
66048-4435
US

IV. Provider business mailing address

3909 ROWLAND AVE
KANSAS CITY KS
66104-3525
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-5118
  • Fax:
Mailing address:
  • Phone: 913-321-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSCSW1956
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: