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General NPI Number Information
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NPI Number | 1487279279
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Entity Type | Individual
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Provider Name | KELLEY FOSTER M.C.D., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 2821 W DIXON RD
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City | LITTLE ROCK
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State | AR
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Zip | 72206-4256
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Country | US
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Telephone | 501-888-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 W DIXON RD
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City | LITTLE ROCK
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State | AR
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Zip | 72206-4256
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Country | US
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Telephone | 501-888-4200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6367
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 201098
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License Number State | AR
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