Healthcare Provider Details

I. General information

NPI: 1447551452
Provider Name (Legal Business Name): JEANA FOSTER ANDERSON MA-CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2010
Last Update Date: 11/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HAWTHORNE ST STE 3
MEDFORD OR
97504-7166
US

IV. Provider business mailing address

45 HAWTHORNE ST STE 3
MEDFORD OR
97504-7166
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-4484
  • Fax: 541-772-4494
Mailing address:
  • Phone: 541-772-4484
  • Fax: 541-772-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number23299
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: