Healthcare Provider Details

I. General information

NPI: 1831768696
Provider Name (Legal Business Name): NATALIE FISCHER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date: 11/07/2023
Reactivation Date: 11/14/2023

III. Provider practice location address

4867 E BELTLINE AVE NE STE 4
GRAND RAPIDS MI
49525-9787
US

IV. Provider business mailing address

2150 PINEWOOD ST
JENISON MI
49428-9118
US

V. Phone/Fax

Practice location:
  • Phone: 815-844-6109
  • Fax: 815-844-3561
Mailing address:
  • Phone: 616-202-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: