Provider Demographics
NPI:1255417234
Name:FISHER, CLYDIA RENEE (BSBS,MSW)
Entity type:Individual
Prefix:
First Name:CLYDIA
Middle Name:RENEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:BSBS,MSW
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 852
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-0852
Mailing Address - Country:US
Mailing Address - Phone:205-384-4539
Mailing Address - Fax:205-384-1496
Practice Address - Street 1:1200 BEACON LN
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504
Practice Address - Country:US
Practice Address - Phone:205-384-4539
Practice Address - Fax:205-384-1496
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker