Provider Demographics
NPI:1851418545
Name:FISHER, JANELLE KIANNA
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:KIANNA
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 ARNOLD AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2528
Mailing Address - Country:US
Mailing Address - Phone:916-265-4008
Mailing Address - Fax:
Practice Address - Street 1:4931 ARNOLD AVE STE 10
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2528
Practice Address - Country:US
Practice Address - Phone:916-265-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical