Provider Demographics
NPI:1942752803
Name:FOSTER, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6302
Mailing Address - Country:US
Mailing Address - Phone:972-424-0148
Mailing Address - Fax:
Practice Address - Street 1:3880 PARKWOOD BLVD
Practice Address - Street 2:BLDG 5, SUITE 502
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1928
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist