Individual
MRS. AGNES-MARIE LORRAINE FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
Mailing address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000003729
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1524926
—
TN
Enumeration date
05/11/2011
Last updated
01/29/2014
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