Provider Demographics
NPI:1235639220
Name:FISHER, SUSAN M (LLMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:155 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3407
Mailing Address - Country:US
Mailing Address - Phone:269-962-3768
Mailing Address - Fax:
Practice Address - Street 1:155 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3407
Practice Address - Country:US
Practice Address - Phone:269-962-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801101904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker