Provider Demographics
NPI:1528282506
Name:FOX, KRISTIN LEIGH (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEIGH
Last Name:FOX
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 MEDINA RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5374
Mailing Address - Country:US
Mailing Address - Phone:330-596-1042
Mailing Address - Fax:330-532-0038
Practice Address - Street 1:1065 MEDINA RD STE 300
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5374
Practice Address - Country:US
Practice Address - Phone:330-596-1042
Practice Address - Fax:330-532-0038
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00088841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical