Provider Demographics
NPI:1407192446
Name:FISCHER, SUSAN DARLENE (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DARLENE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 CHEYENNE CT NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2308
Mailing Address - Country:US
Mailing Address - Phone:503-510-4229
Mailing Address - Fax:
Practice Address - Street 1:3289 CHEYENNE CT NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-2308
Practice Address - Country:US
Practice Address - Phone:503-510-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist