Provider Demographics
NPI:1598549016
Name:FOSTER, NIKITA JEAN (SLP)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:JEAN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2235
Mailing Address - Street 2:
Mailing Address - City:PATEROS
Mailing Address - State:WA
Mailing Address - Zip Code:98846-2235
Mailing Address - Country:US
Mailing Address - Phone:509-885-6202
Mailing Address - Fax:
Practice Address - Street 1:619 W BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9700
Practice Address - Country:US
Practice Address - Phone:509-826-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61457841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist