Provider Demographics
NPI:1972541233
Name:FOSTER, JEAN LOUISE (MA-CCC/SLP,)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:LOUISE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA-CCC/SLP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11618 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3014
Mailing Address - Country:US
Mailing Address - Phone:314-842-1900
Mailing Address - Fax:
Practice Address - Street 1:11618 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3014
Practice Address - Country:US
Practice Address - Phone:314-842-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102623235Z00000X
IL146004057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist