MEDICARE: MRS. JEAN LOUISE FOSTER M.A.-C.C.C./S.L.P,

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	102623	MO
2	235Z00000X	Speech-Language Pathologist	146004057	IL

General Provider Information

NPI Number	:	1972541233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN LOUISE FOSTER M.A.-C.C.C./S.L.P,

Provider Business Mailing Address
First Line	:	11618 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-3014
Country	:	US
Telephone Number	:	314-842-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	11618 GRAVOIS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-3014
Country	:	US
Telephone Number	:	314-842-1900
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/19/2014

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Directions to “ MRS. JEAN LOUISE FOSTER M.A.-C.C.C./S.L.P,” Practice Location

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