Provider Demographics
NPI:1578217303
Name:FOSTER, LETA JO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LETA
Middle Name:JO
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N BOWIE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-1810
Mailing Address - Country:US
Mailing Address - Phone:903-667-2328
Mailing Address - Fax:903-667-5151
Practice Address - Street 1:700 N BOWIE ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-1810
Practice Address - Country:US
Practice Address - Phone:903-667-2328
Practice Address - Fax:903-667-5151
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist