Provider Demographics
NPI:1811938939
Name:FOX, CALVIN BRENT (MCH, CCC-A)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:BRENT
Last Name:FOX
Suffix:
Gender:M
Credentials:MCH, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 E 3900 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1476
Mailing Address - Country:US
Mailing Address - Phone:801-272-1232
Mailing Address - Fax:801-272-1238
Practice Address - Street 1:1377 E 3900 S
Practice Address - Street 2:SUITE 201
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1476
Practice Address - Country:US
Practice Address - Phone:801-272-1232
Practice Address - Fax:801-272-1238
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT100988-4101231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000002761Medicare ID - Type Unspecified