Healthcare Provider Details

I. General information

NPI: 1386431484
Provider Name (Legal Business Name): SHAUNA K FISHER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W WORLEY ST
COLUMBIA MO
65203-1038
US

IV. Provider business mailing address

2108 HILLSBORO DR
COLUMBIA MO
65202-3176
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-3400
  • Fax:
Mailing address:
  • Phone: 573-303-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: