Provider Demographics
NPI:1184130569
Name:FISHER, JODACY LYNN (AAS, QMHS)
Entity type:Individual
Prefix:
First Name:JODACY
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:AAS, QMHS
Other - Prefix:
Other - First Name:JODACY
Other - Middle Name:LYNN
Other - Last Name:HUTCHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:2845 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1720
Mailing Address - Country:US
Mailing Address - Phone:740-454-9766
Mailing Address - Fax:740-588-6452
Practice Address - Street 1:1375 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9511
Practice Address - Country:US
Practice Address - Phone:740-342-5154
Practice Address - Fax:740-342-6704
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator