Provider Demographics
NPI:1497228829
Name:FOSTER, LAURA LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 SPRINGBORN RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:MI
Mailing Address - Zip Code:48064-3503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11700 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-3903
Practice Address - Country:US
Practice Address - Phone:586-353-3800
Practice Address - Fax:586-759-3552
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist