Provider Demographics
NPI:1114168762
Name:FISHER, SUSAN ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W BOXELDER RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5320
Mailing Address - Country:US
Mailing Address - Phone:307-686-7779
Mailing Address - Fax:307-686-9494
Practice Address - Street 1:405 W BOXELDER RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5320
Practice Address - Country:US
Practice Address - Phone:307-686-7779
Practice Address - Fax:307-686-9494
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016601103TC0700X
WY486103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical