Healthcare Provider Details

I. General information

NPI: 1255704532
Provider Name (Legal Business Name): VICTORIA FISHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 BROADWAY AVE NW APT 2
GRAND RAPIDS MI
49504-4215
US

IV. Provider business mailing address

1971 E BELTLINE AVE NE STE 106-812
GRAND RAPIDS MI
49525-7045
US

V. Phone/Fax

Practice location:
  • Phone: 517-677-1233
  • Fax:
Mailing address:
  • Phone: 616-259-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: