Provider Demographics
NPI:1346891231
Name:FOX, KECIA (LAC)
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 SE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1906
Mailing Address - Country:US
Mailing Address - Phone:541-604-8087
Mailing Address - Fax:
Practice Address - Street 1:736 SE 60TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1906
Practice Address - Country:US
Practice Address - Phone:541-604-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist