Provider Demographics
NPI:1528382835
Name:FOSTER, HOLLY KRUEGER (MSCCC-SP #411)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:KRUEGER
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MSCCC-SP #411
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 WILLOWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-3441
Mailing Address - Country:US
Mailing Address - Phone:205-587-6847
Mailing Address - Fax:
Practice Address - Street 1:2547 WILLOWBROOK CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-3441
Practice Address - Country:US
Practice Address - Phone:205-587-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-34657FOSOtherBLUE CROSS/BLUE SHIELD OF ALABAMA