Provider Demographics
NPI:1104579903
Name:FOX, KATIE MARIE (SUDPT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:FOX
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7641
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-0415
Mailing Address - Country:US
Mailing Address - Phone:509-279-1902
Mailing Address - Fax:
Practice Address - Street 1:4324 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1209
Practice Address - Country:US
Practice Address - Phone:509-315-8682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO691149829101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)