Provider Demographics
NPI:1770821597
Name:FISHER, CORRY MARIE (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORRY
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 THREE CENT LN
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-9211
Mailing Address - Country:US
Mailing Address - Phone:717-667-6383
Mailing Address - Fax:
Practice Address - Street 1:69 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:17058-7030
Practice Address - Country:US
Practice Address - Phone:717-436-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist