Provider Demographics
NPI:1477962264
Name:FOSTER, HOLLY DELCLOS (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:DELCLOS
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:LYNNE
Other - Last Name:DELCLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:510 ANN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3804
Mailing Address - Country:US
Mailing Address - Phone:501-231-4454
Mailing Address - Fax:
Practice Address - Street 1:16105 ARKANSAS 5
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-743-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205455721Medicaid