Provider Demographics
NPI:1477124279
Name:FOX, CHRISTALEE MICHELLE (THW)
Entity Type:Individual
Prefix:
First Name:CHRISTALEE
Middle Name:MICHELLE
Last Name:FOX
Suffix:
Gender:F
Credentials:THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 COMMERCIAL ST SE STE 180
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4087
Mailing Address - Country:US
Mailing Address - Phone:503-363-8068
Mailing Address - Fax:503-930-3161
Practice Address - Street 1:209 SW 4TH AVE STE 520
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1825
Practice Address - Country:US
Practice Address - Phone:503-988-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist