Provider Demographics
NPI:1477843191
Name:FOX, DANA R (HIS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:FOX
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1910
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-1910
Mailing Address - Country:US
Mailing Address - Phone:208-946-7827
Mailing Address - Fax:
Practice Address - Street 1:2566 KOOTENAI TRAIL RD
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-4900
Practice Address - Country:US
Practice Address - Phone:208-946-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA 1974237700000X
MT404237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist