Provider Demographics
NPI:1326371246
Name:FISCHER, REBECCA RUTH (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RUTH
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19230 EVANS ST NW STE 109
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1079
Mailing Address - Country:US
Mailing Address - Phone:952-232-6054
Mailing Address - Fax:952-232-6350
Practice Address - Street 1:19230 EVANS ST NW STE 109
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1079
Practice Address - Country:US
Practice Address - Phone:952-232-6054
Practice Address - Fax:952-232-6350
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680003277OtherMEDICARE PTAN
MNH400140126OtherMEDICARE PTAN FOR HEALTHWISE
MN176622000Medicaid
MN680003277Medicare PIN
MNH400140126Medicare PIN