Provider Demographics
NPI:1922231935
Name:FISCHER, LYNNETTE (PHD, LP)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1124 COLUMBIA ST
Practice Address - Street 2:STE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2026
Practice Address - Country:US
Practice Address - Phone:206-219-2090
Practice Address - Fax:206-215-3099
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5103103TC0700X
WAPY60244031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical