Provider Demographics
NPI:1376322867
Name:FISK, DESIREE (BSW)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:FISK
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 E BERRY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9627
Mailing Address - Country:US
Mailing Address - Phone:517-789-1213
Mailing Address - Fax:
Practice Address - Street 1:1200 N WEST AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2174
Practice Address - Country:US
Practice Address - Phone:517-789-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker