Provider Demographics
NPI:1477604346
Name:FISHER, REBECCA (SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:SLP
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 2829
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-2829
Mailing Address - Country:US
Mailing Address - Phone:912-756-5699
Mailing Address - Fax:
Practice Address - Street 1:2709 US HIGHWAY 17
Practice Address - Street 2:BLDG 2A
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3775
Practice Address - Country:US
Practice Address - Phone:912-756-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist