Provider Demographics
NPI:1487171070
Name:FOX, NICOLE RENEE (AUD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:FOX
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 SE HOLGATE BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3167
Mailing Address - Country:US
Mailing Address - Phone:619-908-9579
Mailing Address - Fax:
Practice Address - Street 1:14411 NE 20TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6432
Practice Address - Country:US
Practice Address - Phone:360-256-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30888231H00000X
WALD60797475231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist