Provider Demographics
NPI:1912317645
Name:FISHER, JENNIFER (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 UNIVERSITY AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8928
Mailing Address - Country:US
Mailing Address - Phone:515-996-0120
Mailing Address - Fax:
Practice Address - Street 1:14225 UNIVERSITY AVE STE 260
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8928
Practice Address - Country:US
Practice Address - Phone:515-996-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072722101YM0800X
IA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health