MEDICARE: PROF. JENNIFER MICHELLE FOSTER MA, CD, IBCLC, RLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor
4	103T00000X	Psychologist
5	133N00000X	Nutritionist
6	133V00000X	Registered Dietitian
7	171M00000X	Case Manager/Care Coordinator
8	172V00000X	Community Health Worker
9	332900000X	Non-Pharmacy Dispensing Site
10	372500000X	Chore Provider
11	374J00000X	Doula
12	374T00000X	Religious Nonmedical Nursing Personnel
13	376J00000X	Homemaker
14	174N00000X	Lactation Consultant (Non-RN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A536433835890	OTHER	FL	FLORIDA DRIVER'S LICENSE
2	26-3017550	OTHER	FL	1275870172

General Provider Information

NPI Number	:	1275870172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JENNIFER MICHELLE FOSTER MA, CD, IBCLC, RLC

Provider Business Mailing Address
First Line	:	213 RUSSELL CT
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-2918
Country	:	US
Telephone Number	:	470-533-9119
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 RUSSELL CT
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-2918
Country	:	US
Telephone Number	:	470-533-9119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	11/02/2020

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