Provider Demographics
NPI:1508449067
Name:FISCHER, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24864 AUTUMN RDG
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2402
Mailing Address - Country:US
Mailing Address - Phone:847-525-8662
Mailing Address - Fax:
Practice Address - Street 1:13400 RIVERSIDE DR STE 209
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2545
Practice Address - Country:US
Practice Address - Phone:818-308-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015522235Z00000X
CA30397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist