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NPI Code Detail

MEDICARE: LOGAN MAE FISH

MEDICARE: LOGAN MAE FISH
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
1374J00000XDoula
21041C0700XClinical Social Worker6801121280MI

General Provider Information

NPI Number : 1851926307
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN MAE FISH
Provider Business Mailing Address
First Line : 2880 MISSION DR
Second Line :
City : SHELBYVILLE
State : MI
Zip : 49344-9580
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2880 MISSION DR
Second Line :
City : SHELBYVILLE
State : MI
Zip : 49344-9580
Country : US
Telephone Number : 732-545-6335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2020
Last Update Date : 02/19/2026

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Directions to “ LOGAN MAE FISH ” Practice Location

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