Individual
MR. BRUCE R FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LICSW
Contact information
Practice address
2550 UNIVERSITY AVE W, SUITE 435 S., SAINT PAUL, MN 55114-1052
(651) 647-1900
(651) 647-1861
Mailing address
3310 NICOLLET AVE, #406, MINNEAPOLIS, MN 55408-4495
(612) 309-5965
(651) 647-1861
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1634
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
968557000
—
MN
Enumeration date
02/22/2006
Last updated
01/27/2014
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