Provider Demographics
NPI:1609396001
Name:FOUSS, JEREMY ALAN
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ALAN
Last Name:FOUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9304
Mailing Address - Country:US
Mailing Address - Phone:919-583-5375
Mailing Address - Fax:919-583-5235
Practice Address - Street 1:3888 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9304
Practice Address - Country:US
Practice Address - Phone:919-583-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP12507235Z00000X
NC14438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid
AB7360731OtherMEDICARE PIN