Provider Demographics
NPI:1366128480
Name:FISCHER, KAIA ODELL
Entity type:Individual
Prefix:
First Name:KAIA
Middle Name:ODELL
Last Name:FISCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 12TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1231
Mailing Address - Country:US
Mailing Address - Phone:303-850-2695
Mailing Address - Fax:
Practice Address - Street 1:700 12TH ST STE 220
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1231
Practice Address - Country:US
Practice Address - Phone:303-850-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020914101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor