Provider Demographics
NPI:1407518483
Name:FOSKETT, JENNIFER ROSEMARIE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSEMARIE
Last Name:FOSKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9752
Mailing Address - Country:US
Mailing Address - Phone:248-697-7380
Mailing Address - Fax:
Practice Address - Street 1:5570 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9752
Practice Address - Country:US
Practice Address - Phone:248-697-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional