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NPI Code Detail

MEDICARE: JULLYSA WYNELL CORRINNE FOX

MEDICARE: JULLYSA WYNELL CORRINNE 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
1103K00000XBehavior Analyst
2175T00000XPeer Specialist
3106S00000XBehavior Technician61379883WA

General Provider Information

NPI Number : 1558925172
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULLYSA WYNELL CORRINNE FOX
Provider Business Mailing Address
First Line : 748 14TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2315
Country : US
Telephone Number : 360-200-5419
Fax Number :
Provider Business Practice Location Address
First Line : 1720 N HAMILTON ST
Second Line :
City : SPOKANE
State : WA
Zip : 99207-2474
Country : US
Telephone Number : 360-915-6868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2019
Last Update Date : 12/19/2024

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Directions to “ JULLYSA WYNELL CORRINNE FOX ” Practice Location

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