Provider Demographics
NPI:1578282711
Name:FOX, ALISSA JOY
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JOY
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 1:1078 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1614
Mailing Address - Country:US
Mailing Address - Phone:724-986-8742
Mailing Address - Fax:
Practice Address - Street 1:1078 8TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1614
Practice Address - Country:US
Practice Address - Phone:724-986-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10350235Z00000X
PASL008062235Z00000X
WVSLP-2328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist