Provider Demographics
NPI:1255683256
Name:FOSTER, REBECCA H (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:H
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:DEPT. OF PSYCHOLOGY (3N-14)
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6069
Mailing Address - Fax:314-454-4013
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT. OF PSYCHOLOGY (3N-14)
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6069
Practice Address - Fax:314-454-4013
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014029000103TC0700X
WI3047103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent