Provider Demographics
NPI:1609082627
Name:FOX, DIANE M (BC-HIS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:RICKARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:218 E RIO VISTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233
Mailing Address - Country:US
Mailing Address - Phone:360-707-5500
Mailing Address - Fax:360-707-5600
Practice Address - Street 1:218 E RIO VISTA AVENUE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233
Practice Address - Country:US
Practice Address - Phone:360-707-5500
Practice Address - Fax:360-707-5600
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00002405237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0172322OtherLABOR AND INDUSTRIES