Provider Demographics
NPI:1093834749
Name:FOSTER-STRONG, JERRLENE (CDS)
Entity Type:Individual
Prefix:
First Name:JERRLENE
Middle Name:
Last Name:FOSTER-STRONG
Suffix:
Gender:F
Credentials:CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14452 PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-1838
Mailing Address - Country:US
Mailing Address - Phone:708-596-5845
Mailing Address - Fax:
Practice Address - Street 1:14452 PEORIA ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-1838
Practice Address - Country:US
Practice Address - Phone:708-596-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist