Provider Demographics
NPI:1447551452
Name:ANDERSON, JEANA FOSTER (MA-CCC-A)
Entity type:Individual
Prefix:MS
First Name:JEANA
Middle Name:FOSTER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HAWTHORNE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7166
Mailing Address - Country:US
Mailing Address - Phone:541-772-4484
Mailing Address - Fax:541-772-4494
Practice Address - Street 1:45 HAWTHORNE ST STE 3
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7166
Practice Address - Country:US
Practice Address - Phone:541-772-4484
Practice Address - Fax:541-772-4494
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23299237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR23299OtherBOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY