Provider Demographics
NPI:1588925275
Name:FOX, KERRY LORRAINE (SLP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:LORRAINE
Last Name:FOX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:LORRAINE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4415 S HARVARD AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-9700
Mailing Address - Country:US
Mailing Address - Phone:918-508-7601
Mailing Address - Fax:918-508-7602
Practice Address - Street 1:4415 S HARVARD AVE STE 125
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-9700
Practice Address - Country:US
Practice Address - Phone:918-508-7601
Practice Address - Fax:918-508-7602
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist