Provider Demographics
NPI:1740953892
Name:FISHER, BRODIE
Entity type:Individual
Prefix:
First Name:BRODIE
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 8TH AVE S APT J106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5505
Mailing Address - Country:US
Mailing Address - Phone:530-356-5511
Mailing Address - Fax:
Practice Address - Street 1:10102 8TH AVE S APT J106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-5505
Practice Address - Country:US
Practice Address - Phone:530-356-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician