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General NPI Number Information
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NPI Number | 1144342478
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Entity Type | Organization
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Legal Business Name | WANDA G. FOX
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 819 HWY 2 PIONEER SQ. 204
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City | SANDPOINT
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State | ID
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Zip | 83864-0000
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Country | US
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Telephone | 208-265-0745
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Fax | 208-255-1543
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Provider Business Mailing Address
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Address Line | 819 HWY 2 PIONEER SQ. 204
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City | SANDPOINT
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State | ID
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Zip | 83864-0000
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Country | US
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Telephone | 208-265-0745
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Fax | 208-255-1543
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. WANDA G. FOX
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Credential | LSW,MSW
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Telephone | 208-265-0745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LSW-2722
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LSW-2722
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License Number State | ID
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