MEDICARE: ANGELA MARIE FLEISHANS FISH PH.D., LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	6301013986	MI
2	103TC0700X	Clinical Psychologist	6301013986	MI

General Provider Information

NPI Number	:	1316117088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE FLEISHANS FISH PH.D., LP

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S 5TH AVE
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-2216
Country	:	US
Telephone Number	:	734-764-9466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	02/03/2024

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