Provider Demographics
NPI:1083898308
Name:FIFER, JOHNNA D
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:D
Last Name:FIFER
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 1:749 DRISKILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2202
Mailing Address - Country:US
Mailing Address - Phone:816-776-6912
Mailing Address - Fax:816-776-5554
Practice Address - Street 1:749 DRISKILL DR
Practice Address - Street 2:RICHMOND R-XVI
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2202
Practice Address - Country:US
Practice Address - Phone:816-776-6912
Practice Address - Fax:816-776-5554
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist