Provider Demographics
NPI:1124338959
Name:FISHER, LAYA E (MA CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:LAYA
Middle Name:E
Last Name:FISHER
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 1:1273 MEDINA CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3702
Mailing Address - Country:US
Mailing Address - Phone:732-363-6731
Mailing Address - Fax:
Practice Address - Street 1:1273 MEDINA CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3702
Practice Address - Country:US
Practice Address - Phone:732-363-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist