Healthcare Provider Details

I. General information

NPI: 1699687939
Provider Name (Legal Business Name): JILL FISHER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 12TH ST
MOSINEE WI
54455-1003
US

IV. Provider business mailing address

1000 HIGH ST
MOSINEE WI
54455-1343
US

V. Phone/Fax

Practice location:
  • Phone: 715-693-2810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number659719
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: