Provider Demographics
NPI:1730698465
Name:FOX, KATHRYN (LICSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 IDAHO RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9491
Mailing Address - Country:US
Mailing Address - Phone:802-558-4696
Mailing Address - Fax:
Practice Address - Street 1:2610 IDAHO RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9491
Practice Address - Country:US
Practice Address - Phone:802-558-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097-0114018104100000X
IL149.0238291041C0700X
VT089.01227441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker