Provider Demographics
NPI:1265151492
Name:FOX, CALLIE E (SAC-IT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:E
Last Name:FOX
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MONROE ST STE 365
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2059
Mailing Address - Country:US
Mailing Address - Phone:920-509-9738
Mailing Address - Fax:
Practice Address - Street 1:1930 MONROE ST STE 365
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2059
Practice Address - Country:US
Practice Address - Phone:920-509-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19482-130101YA0400X
WI7726-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)