Provider Demographics
NPI:1790818565
Name:FISHER, DARCY SUZANNE (MS)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:SUZANNE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SIENNA DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-9445
Mailing Address - Country:US
Mailing Address - Phone:419-795-0470
Mailing Address - Fax:479-795-0470
Practice Address - Street 1:301 SE 28TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4195
Practice Address - Country:US
Practice Address - Phone:479-464-8686
Practice Address - Fax:479-464-8687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12026462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist