Healthcare Provider Details

I. General information

NPI: 1689908485
Provider Name (Legal Business Name): BREANNA FAITH FISCHER MSMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANNA FAITH AGNOR MSMFT

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR
VANCOUVER WA
98662-6347
US

IV. Provider business mailing address

1845 SE 106TH AVE
PORTLAND OR
97216-2935
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax: 360-567-2212
Mailing address:
  • Phone: 360-798-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: