Provider Demographics
NPI:1396882460
Name:COX, PATRICIA J (LCSW, PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:COX
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WACO WAY
Mailing Address - Street 2:
Mailing Address - City:POPLAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61065-8253
Mailing Address - Country:US
Mailing Address - Phone:815-544-3268
Mailing Address - Fax:815-547-6728
Practice Address - Street 1:800 WACO WAY
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-8253
Practice Address - Country:US
Practice Address - Phone:815-544-3268
Practice Address - Fax:815-547-6728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000116A1041C0700X
IN35000073A106H00000X
IN28053496A163W00000X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse