Provider Demographics
NPI:1689867772
Name:FISHER, THERESA CHRISTINA (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:CHRISTINA
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 E GRAND AVE
Mailing Address - Street 2:#209
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-5915
Mailing Address - Country:US
Mailing Address - Phone:847-265-1460
Mailing Address - Fax:847-265-1650
Practice Address - Street 1:1011 N GREEN ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5720
Practice Address - Country:US
Practice Address - Phone:815-385-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist