Provider Demographics
NPI:1336620145
Name:FOX, ANGELA JILL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JILL
Last Name:FOX
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 OAKCREST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2316
Mailing Address - Country:US
Mailing Address - Phone:940-765-1778
Mailing Address - Fax:
Practice Address - Street 1:2244 BRINKER RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6120
Practice Address - Country:US
Practice Address - Phone:940-320-6300
Practice Address - Fax:940-380-9610
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist