Provider Demographics
NPI:1043281421
Name:FISHER, ANN M (MS ED, LMHC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS ED, LMHC, LCPC
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 MIDDLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3287
Mailing Address - Country:US
Mailing Address - Phone:563-445-2375
Mailing Address - Fax:563-359-1768
Practice Address - Street 1:2550 MIDDLE RD STE 300
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3287
Practice Address - Country:US
Practice Address - Phone:563-445-2375
Practice Address - Fax:563-359-1768
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00893101YM0800X
IL180005397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional