Provider Demographics
NPI:1467623702
Name:FOX, SARA LORRAINE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:LORRAINE
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 1:7727 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4320
Mailing Address - Country:US
Mailing Address - Phone:612-455-0304
Mailing Address - Fax:612-861-0186
Practice Address - Street 1:7727 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4320
Practice Address - Country:US
Practice Address - Phone:612-455-0304
Practice Address - Fax:612-861-0186
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist