Provider Demographics
NPI:1275531097
Name:FISCHER, JOY IRENE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:IRENE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:I
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7267 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-9767
Mailing Address - Country:US
Mailing Address - Phone:952-240-9011
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1064
Practice Address - Country:US
Practice Address - Phone:952-240-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MN109641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN477492200Medicaid