Provider Demographics
NPI:1235791690
Name:FOSTER, JENNIFER LYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-5660
Mailing Address - Country:US
Mailing Address - Phone:360-607-0148
Mailing Address - Fax:
Practice Address - Street 1:403 E OAK ST
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-5660
Practice Address - Country:US
Practice Address - Phone:360-607-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10200597103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst