| Wanda G. Fox | |
|
819 Hwy 2 Pioneer Sq. 204 Sandpoint ID 83864-0000 | |
| (208) 265-0745 | |
| (208) 255-1543 |
| Full Name | Wanda G. Fox |
|---|---|
| Speciality | Case Management |
| Location | 819 Hwy 2 Pioneer Sq. 204, Sandpoint, Idaho |
| Authorized Official Name and Position | Wanda G. Fox (PROGRAM DIRECTOR) |
| Authorized Official Contact | 2082650745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wanda G. Fox 819 Hwy 2 Pioneer Sq. 204 Sandpoint ID 83864-0000 Ph: (208) 265-0745 | Wanda G. Fox 819 Hwy 2 Pioneer Sq. 204 Sandpoint ID 83864-0000 Ph: (208) 265-0745 |
| NPI Number | 1144342478 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 07/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144342478 | NPI | - | NPPES |
| 8068102 | Medicaid | ID | |
| 8068389 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LSW-2722 (Idaho) | Secondary |
| 251B00000X | Case Management | LSW-2722 (Idaho) | Primary |
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