Provider Demographics
NPI:1366990509
Name:FISHER, WENDY SUE
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:SUE
Last Name:FISHER
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 1:2010 TIGER PRIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-8601
Mailing Address - Country:US
Mailing Address - Phone:660-851-5300
Mailing Address - Fax:660-851-5394
Practice Address - Street 1:2010 TIGER PRIDE BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-8601
Practice Address - Country:US
Practice Address - Phone:660-851-5300
Practice Address - Fax:660-851-5394
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015034690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist