Provider Demographics
NPI:1780820159
Name:FISHER, BOBBI L (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9710
Mailing Address - Country:US
Mailing Address - Phone:570-268-2385
Mailing Address - Fax:570-268-2379
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9710
Practice Address - Country:US
Practice Address - Phone:570-268-2385
Practice Address - Fax:570-268-2379
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL009430OtherLICENSE NUMBER