Healthcare Provider Details

I. General information

NPI: 1750297651
Provider Name (Legal Business Name): RODERICK ALAN FISHER III RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 101ST TER STE 350
KANSAS CITY MO
64131-5310
US

IV. Provider business mailing address

7626 WATSON RD APT B302
SAINT LOUIS MO
63119-5722
US

V. Phone/Fax

Practice location:
  • Phone: 816-371-4180
  • Fax:
Mailing address:
  • Phone: 573-233-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-460875
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: