Provider Demographics
NPI:1033367321
Name:DE FISHER, CHRISTINE R (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:DE FISHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5598 PEASE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9368
Mailing Address - Country:US
Mailing Address - Phone:315-589-2543
Mailing Address - Fax:315-589-2539
Practice Address - Street 1:5598 PEASE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9368
Practice Address - Country:US
Practice Address - Phone:315-589-2543
Practice Address - Fax:315-589-2539
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004923 -1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist