Healthcare Provider Details

I. General information

NPI: 1619832375
Provider Name (Legal Business Name): JAMAL FISHER THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 HEADLEY ST SE UNIT 572
ADA MI
49301-4519
US

IV. Provider business mailing address

7125 HEADLEY ST SE UNIT 572
ADA MI
49301-4519
US

V. Phone/Fax

Practice location:
  • Phone: 616-433-1045
  • Fax:
Mailing address:
  • Phone: 616-433-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMAL FISHER
Title or Position: OWNER
Credential: LMSW
Phone: 616-433-1045