Provider Demographics
NPI:1134405525
Name:FISHER, MARY - KATHERINE R (MS,CCC-SLP,L-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY - KATHERINE
Middle Name:R
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS,CCC-SLP,L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 S MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9562
Mailing Address - Country:US
Mailing Address - Phone:585-344-1239
Mailing Address - Fax:
Practice Address - Street 1:3723 S MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9562
Practice Address - Country:US
Practice Address - Phone:585-344-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006209-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist