Healthcare Provider Details

I. General information

NPI: 1497228829
Provider Name (Legal Business Name): LAURA LYNN FOSTER MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 E 10 MILE RD
WARREN MI
48089-3903
US

IV. Provider business mailing address

9702 SPRINGBORN RD
CASCO MI
48064-3503
US

V. Phone/Fax

Practice location:
  • Phone: 586-353-3800
  • Fax: 586-759-3552
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: