Provider Demographics
NPI:1144570706
Name:FISHER, KEVIN (LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 OAKWOOD HILLS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4458
Mailing Address - Country:US
Mailing Address - Phone:534-444-4562
Mailing Address - Fax:534-444-4563
Practice Address - Street 1:3703 OAKWOOD HILLS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4458
Practice Address - Country:US
Practice Address - Phone:534-444-4562
Practice Address - Fax:534-444-4563
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67731101YP2500X
COLPC.0012689101YP2500X
WI10321-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26980053Medicaid