Provider Demographics
NPI:1255645420
Name:FOSTER, LISA ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
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 1:6143 STATE ROUTE 417
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:NY
Mailing Address - Zip Code:14801-9515
Mailing Address - Country:US
Mailing Address - Phone:607-684-4579
Mailing Address - Fax:
Practice Address - Street 1:6143 STATE ROUTE 417
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:NY
Practice Address - Zip Code:14801-9515
Practice Address - Country:US
Practice Address - Phone:607-684-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015145-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist