Provider Demographics
NPI:1770061665
Name:FISCHER, ROBERTA J (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2918
Mailing Address - Country:US
Mailing Address - Phone:610-225-2451
Mailing Address - Fax:
Practice Address - Street 1:378 GRANGE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2918
Practice Address - Country:US
Practice Address - Phone:610-225-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000686L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist