Provider Demographics
NPI:1609044866
Name:FISHER, KRISTEN RACKL (LPN, BS, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RACKL
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPN, BS, CASAC
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:RACKL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN, BS
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:34 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1326
Practice Address - Country:US
Practice Address - Phone:585-786-0220
Practice Address - Fax:585-786-3631
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22077101YA0400X
NY277387164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse