Healthcare Provider Details

I. General information

NPI: 1982027546
Provider Name (Legal Business Name): JACQUELINE D. FOSTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 RIVERSIDE DR SUITE 318
SHERMAN OAKS CA
91423-2500
US

IV. Provider business mailing address

PO BOX 5104
CHATSWORTH CA
91313-5104
US

V. Phone/Fax

Practice location:
  • Phone: 818-469-2923
  • Fax:
Mailing address:
  • Phone: 818-469-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number13884
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number13884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: