Provider Demographics
NPI:1417043126
Name:FISHER, BARBARA JANE (MALP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5047 GLADSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3345 LEXINGTON AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2276
Practice Address - Country:US
Practice Address - Phone:651-454-4628
Practice Address - Fax:651-454-9494
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3608103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN312P9FIOtherBCBS
MN62-69553OtherMEDICA