Provider Demographics
NPI:1013549021
Name:FISCHER, JACI LENAYE
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:LENAYE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 SPRUCE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8446
Mailing Address - Country:US
Mailing Address - Phone:269-779-9023
Mailing Address - Fax:
Practice Address - Street 1:977 SPRUCE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8446
Practice Address - Country:US
Practice Address - Phone:269-779-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician