Provider Demographics
NPI:1750493870
Name:FISHER, KIMBERLY SUZANNE (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUZANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13925 COALFIELD COMMONS PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-1216
Mailing Address - Country:US
Mailing Address - Phone:804-818-0000
Mailing Address - Fax:804-794-1178
Practice Address - Street 1:13925 COALFIELD COMMONS PL
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-1216
Practice Address - Country:US
Practice Address - Phone:804-818-0000
Practice Address - Fax:804-794-1178
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001105231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP35751Medicare UPIN
VA640000111Medicare ID - Type UnspecifiedC03691