Provider Demographics
NPI:1669071858
Name:FISCHER, CHAD RAY (LBSW)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:RAY
Last Name:FISCHER
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2018
Mailing Address - Country:US
Mailing Address - Phone:218-850-8674
Mailing Address - Fax:651-925-0046
Practice Address - Street 1:505 40TH ST S UNIT B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1184
Practice Address - Country:US
Practice Address - Phone:701-478-8440
Practice Address - Fax:651-925-0046
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3508104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker