Provider Demographics
NPI:1003190984
Name:FOX, MAURA D (MSCCC-SLP,NBCT)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:D
Last Name:FOX
Suffix:
Gender:F
Credentials:MSCCC-SLP,NBCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3023
Mailing Address - Country:US
Mailing Address - Phone:518-791-6342
Mailing Address - Fax:
Practice Address - Street 1:1153 BURGOYNE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1135
Practice Address - Country:US
Practice Address - Phone:518-581-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58-005987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist