Provider Demographics
NPI:1578769436
Name:FISHER, POLLY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:POLLY
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6975 SW SANDBURG ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8073
Mailing Address - Country:US
Mailing Address - Phone:503-684-6205
Mailing Address - Fax:503-624-1322
Practice Address - Street 1:6975 SW SANDBURG ST
Practice Address - Street 2:SUITE 340
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8073
Practice Address - Country:US
Practice Address - Phone:503-684-6205
Practice Address - Fax:503-624-1322
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TCHMNMedicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST