Healthcare Provider Details

I. General information

NPI: 1700640794
Provider Name (Legal Business Name): TEENAJOE FISCHER LMSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 8TH ST SOUTH SUITE 200
MOORHEAD MN
56560
US

IV. Provider business mailing address

2837 EVERGREEN RD N
FARGO ND
58102
US

V. Phone/Fax

Practice location:
  • Phone: 218-331-4866
  • Fax: 218-331-4867
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6688
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34178
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: