Provider Demographics
NPI:1245802644
Name:FOX, NORMAN KEATON
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:KEATON
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 N ORION LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6405
Mailing Address - Country:US
Mailing Address - Phone:920-216-2176
Mailing Address - Fax:
Practice Address - Street 1:711 N LYNNDALE DR STE 1A
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3078
Practice Address - Country:US
Practice Address - Phone:920-560-4524
Practice Address - Fax:920-560-6618
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5017-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty