Provider Demographics
NPI:1467067025
Name:FOX, CHRISTIAN LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-824-9335
Practice Address - Street 1:1805 E HOFFER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2443
Practice Address - Country:US
Practice Address - Phone:765-450-7261
Practice Address - Fax:765-450-7284
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22006669AOtherSTATE LICENSE