Provider Demographics
NPI:1447494406
Name:FOX, SUSAN ALYN (MA, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALYN
Last Name:FOX
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 160TH PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1554
Mailing Address - Country:US
Mailing Address - Phone:708-429-4538
Mailing Address - Fax:708-429-4538
Practice Address - Street 1:7440 160TH PL
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1554
Practice Address - Country:US
Practice Address - Phone:708-429-4538
Practice Address - Fax:708-429-4538
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-001900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist