MEDICARE: DR. CAROLYN JEAN FISHER PH.D.

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	103TH0004X	Health Psychologist	7556	OH

General Provider Information

NPI Number	:	1952843245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN JEAN FISHER PH.D.

Provider Business Mailing Address
First Line	:	4041 N HIGH ST STE 102B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3248
Country	:	US
Telephone Number	:	614-431-1418
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 N HIGH ST STE 102B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3248
Country	:	US
Telephone Number	:	614-431-1418
Fax Number	:	614-678-5556

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

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	04/09/2020

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