Provider Demographics
NPI:1306176508
Name:FOX, ALIZA (MHS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, CCC-SLP
Mailing Address - Street 1:7015 N WASHTENAW AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3210
Mailing Address - Country:US
Mailing Address - Phone:773-480-5021
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD STE 18
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1027
Practice Address - Country:US
Practice Address - Phone:847-663-1020
Practice Address - Fax:847-663-1022
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist