Provider Demographics
NPI:1376105734
Name:FOX, PEYTON ANNE
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:ANNE
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3110
Mailing Address - Country:US
Mailing Address - Phone:919-802-6122
Mailing Address - Fax:919-867-6287
Practice Address - Street 1:409 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3110
Practice Address - Country:US
Practice Address - Phone:919-802-6122
Practice Address - Fax:919-867-6287
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2003015OtherSPEECH-LANGUAGE PATHOLOGY LICENSE