Provider Demographics
NPI:1538493150
Name:FISHER, WENDY JEAN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1721
Mailing Address - Country:US
Mailing Address - Phone:512-695-1657
Mailing Address - Fax:
Practice Address - Street 1:2608 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1721
Practice Address - Country:US
Practice Address - Phone:512-695-1657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist