MEDICARE: GABRIELLE FOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	31817	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31817	OTHER	MN	STATE LICENSE

General Provider Information

NPI Number	:	1275475147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE FOX

Provider Business Mailing Address
First Line	:	18598 ELK RIVER TRL
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-8640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18598 ELK RIVER TRL
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-8640
Country	:	US
Telephone Number	:	651-333-0653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ GABRIELLE FOX ” Practice Location

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