Provider Demographics
NPI:1871915546
Name:FOSTER, ELEANOR (MACCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4763
Mailing Address - Country:US
Mailing Address - Phone:870-425-1247
Mailing Address - Fax:870-425-1307
Practice Address - Street 1:1001 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4763
Practice Address - Country:US
Practice Address - Phone:870-425-1247
Practice Address - Fax:870-425-1307
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist