Provider Demographics
NPI:1194812818
Name:FISHER, ALITA ANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:ALITA
Middle Name:ANN
Last Name:FISHER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 ARAGON ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6198
Mailing Address - Country:US
Mailing Address - Phone:850-324-4838
Mailing Address - Fax:
Practice Address - Street 1:3932 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2807
Practice Address - Country:US
Practice Address - Phone:850-434-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSA7424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY906NOtherBLUE CROSS BLUE SHIELD
FLSA7424OtherSTATE LICENSE #
FL889977100Medicaid