Provider Demographics
NPI:1992784912
Name:FOX, CATHERINE ELAINE (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELAINE
Last Name:FOX
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511
Mailing Address - Country:US
Mailing Address - Phone:814-392-2386
Mailing Address - Fax:
Practice Address - Street 1:155 W 8TH ST STE 401
Practice Address - Street 2:ERIE COUNTY CARE MANAGEMENT
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1044
Practice Address - Country:US
Practice Address - Phone:814-871-5170
Practice Address - Fax:814-434-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005422L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL005422LOtherPA LICENSE
PA001870005OtherMEDICAID
09133213OtherAMERICAN SPEECH LANGUAGE
PA001879500Medicaid