Provider Demographics
NPI:1083010029
Name:FISHER, CHANEY
Entity Type:Individual
Prefix:
First Name:CHANEY
Middle Name:
Last Name:FISHER
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 1:3 ROYAL CREST DR APT 9
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6409
Mailing Address - Country:US
Mailing Address - Phone:978-244-0081
Mailing Address - Fax:401-921-3327
Practice Address - Street 1:66 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3948
Practice Address - Country:US
Practice Address - Phone:603-224-3346
Practice Address - Fax:603-224-2149
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA296237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1598891855Medicaid