Healthcare Provider Details

I. General information

NPI: 1972767325
Provider Name (Legal Business Name): MIROSLAVA FOX PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 03/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WILLIAMS WAY
VERNON HILLS IL
60061-3252
US

IV. Provider business mailing address

610 WILLIAMS WAY
VERNON HILLS IL
60061-3252
US

V. Phone/Fax

Practice location:
  • Phone: 847-984-9075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number071007502
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071007502
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007502
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number071007502
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071007502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: