Provider Demographics
NPI:1225289721
Name:MARKS-FOSTER, JENNIFER JUANITA (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUANITA
Last Name:MARKS-FOSTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JUANITA
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 MARSALA CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8620
Mailing Address - Country:US
Mailing Address - Phone:314-724-9187
Mailing Address - Fax:
Practice Address - Street 1:2220 LEMP AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2700
Practice Address - Country:US
Practice Address - Phone:314-814-8777
Practice Address - Fax:314-776-3362
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1225289721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical