Provider Demographics
NPI:1669620100
Name:FISCHER, JEANNE R
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:R
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:R
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 E MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-1695
Mailing Address - Country:US
Mailing Address - Phone:816-540-4700
Mailing Address - Fax:816-540-6035
Practice Address - Street 1:1301 E MYRTLE ST
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-1695
Practice Address - Country:US
Practice Address - Phone:816-540-4700
Practice Address - Fax:816-540-6035
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102370235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO468009501Medicaid