Provider Demographics
NPI:1740364165
Name:FIELDER, JOHN D (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:FIELDER
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 OCCIDENTAL RD
Mailing Address - Street 2:APT 5
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-9691
Mailing Address - Country:US
Mailing Address - Phone:360-936-5362
Mailing Address - Fax:
Practice Address - Street 1:9150 OCCIDENTAL RD
Practice Address - Street 2:APT 5
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-9691
Practice Address - Country:US
Practice Address - Phone:360-936-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8402513Medicaid