Provider Demographics
NPI:1164654133
Name:FISHER, JESSICA JEAN (MED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:JEAN
Other - Last Name:JURGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:12547 W LISBON LN
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3182
Mailing Address - Country:US
Mailing Address - Phone:602-391-5653
Mailing Address - Fax:623-932-7142
Practice Address - Street 1:530 E RILEY DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-2154
Practice Address - Country:US
Practice Address - Phone:623-932-7147
Practice Address - Fax:623-932-7156
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool