Basic Information
| Provider Information | |||||||||
| NPI: | 1912224411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | CORINA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4548 114TH ST | ||||||||
| Address2: | |||||||||
| City: | CHIPPEWA FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547296772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157235585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 617 W CLAIREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547016223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204964700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 7622-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.