Provider Demographics
NPI:1073675054
Name:FISHER, LINDSAY (MA CCC-SCP)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MA CCC-SCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 LONG JOHN SILVER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9675
Mailing Address - Country:US
Mailing Address - Phone:910-742-0575
Mailing Address - Fax:866-263-4369
Practice Address - Street 1:218 LONG JOHN SILVER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9675
Practice Address - Country:US
Practice Address - Phone:910-742-0575
Practice Address - Fax:866-263-4369
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
NC6774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413524Medicaid