Provider Demographics
NPI:1740452655
Name:FOX, WANDA CAROL (MASTERS)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:CAROL
Last Name:FOX
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 YOUNGS CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-4428
Mailing Address - Country:US
Mailing Address - Phone:415-821-4662
Mailing Address - Fax:
Practice Address - Street 1:1738 JEANNE CIR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-6618
Practice Address - Country:US
Practice Address - Phone:925-372-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 5168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist