Provider Demographics
NPI:1932618337
Name:FOSTER, MARY (MA SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 HONAKER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3065
Mailing Address - Country:US
Mailing Address - Phone:304-487-1551
Mailing Address - Fax:304-487-3047
Practice Address - Street 1:1403 HONAKER AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3065
Practice Address - Country:US
Practice Address - Phone:304-487-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist