Provider Demographics
NPI:1598814576
Name:FISHER, TANYA RENEE (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:RENEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3306
Mailing Address - Country:US
Mailing Address - Phone:913-397-6666
Mailing Address - Fax:913-397-0066
Practice Address - Street 1:110 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3306
Practice Address - Country:US
Practice Address - Phone:913-397-6666
Practice Address - Fax:913-397-0066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS37491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical