Provider Demographics
NPI:1275011520
Name:FISK, JO'DEE (LLBSW)
Entity Type:Individual
Prefix:
First Name:JO'DEE
Middle Name:
Last Name:FISK
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GLOCHESKI DR
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2639
Mailing Address - Country:US
Mailing Address - Phone:231-877-2013
Mailing Address - Fax:231-723-1504
Practice Address - Street 1:310 GLOCHESKI DR
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2639
Practice Address - Country:US
Practice Address - Phone:231-877-3012
Practice Address - Fax:231-723-1504
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802089699104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker