Provider Demographics
NPI:1700640794
Name:FISCHER, TEENAJOE (LMSW, LGSW)
Entity type:Individual
Prefix:
First Name:TEENAJOE
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:LMSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 EVERGREEN RD N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2405 8TH ST SOUTH
Practice Address - Street 2:SUITE 200
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-331-4866
Practice Address - Fax:218-331-4867
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND66881041C0700X
MN341781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical