Provider Demographics
NPI:1104915248
Name:FISHER, GARTH E
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:E
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 1:15 W MILWAUKEE ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2998
Mailing Address - Country:US
Mailing Address - Phone:608-755-1475
Mailing Address - Fax:608-755-1733
Practice Address - Street 1:15 W MILWAUKEE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2998
Practice Address - Country:US
Practice Address - Phone:608-755-1475
Practice Address - Fax:608-755-1733
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2000-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39509200Medicaid
WI39509200Medicaid