Healthcare Provider Details

I. General information

NPI: 1477756302
Provider Name (Legal Business Name): ELIZABETH MARIE FISHER MACCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 E SUNSET DR
RITTMAN OH
44270-1165
US

IV. Provider business mailing address

8135 SWARTZ CIR
APPLE CREEK OH
44606-9102
US

V. Phone/Fax

Practice location:
  • Phone: 330-927-2060
  • Fax:
Mailing address:
  • Phone: 330-264-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 5646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: