Provider Demographics
NPI:1255501920
Name:FOSTER, SUSAN TRIMBUR (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TRIMBUR
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W BELMONT AVE
Mailing Address - Street 2:APT 2W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3577
Mailing Address - Country:US
Mailing Address - Phone:773-301-7175
Mailing Address - Fax:
Practice Address - Street 1:1931 W BELMONT AVE
Practice Address - Street 2:APT 2W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3577
Practice Address - Country:US
Practice Address - Phone:773-301-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist