Jack Ralph Fischer, MSW, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1634 Issued in OR

Practice address

780 Commercial St SE
Suite 100
Salem, OR 97301-3462

Phone

(503) 585-5764

Fax

(503) 585-3638

NPI assigned

Jan 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730231960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 COMMERCIAL ST SE",
            "address_2": "SUITE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013462",
            "telephone_number": "503-585-5764",
            "fax_number": "503-585-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 COMMERCIAL ST SE",
            "address_2": "SUITE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013462",
            "telephone_number": "503-585-5764",
            "fax_number": "503-585-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISCHER",
        "first_name": "JACK",
        "middle_name": "RALPH",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "1634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICAL SOC. WK LICENSE",
            "identifier": "1634",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Stefanie Rose Fisco, MT-BC

• Mental Health Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.