Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3343-57 | WI |
Y | 103T00000X | Psychologist | 3343-57 | WI |
NPI | 1003384306 |
---|---|
Provider Name | Dr. Travis Fox |
First Address | Madison, WI 53715-1365 |
Second Address | Madison, WI 53705-4964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 05/11/2018 |