Provider Demographics
NPI:1881964088
Name:FISHER, DEBRA L (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:FISHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2029
Mailing Address - Country:US
Mailing Address - Phone:218-263-7469
Mailing Address - Fax:
Practice Address - Street 1:2910 3RD AVE W
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2029
Practice Address - Country:US
Practice Address - Phone:218-263-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical