Provider Demographics
NPI:1699445239
Name:FOSTER, SHELLY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W CROSSVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7510
Mailing Address - Country:US
Mailing Address - Phone:404-547-0825
Mailing Address - Fax:770-783-6618
Practice Address - Street 1:570 W CROSSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7510
Practice Address - Country:US
Practice Address - Phone:404-547-0825
Practice Address - Fax:770-783-6618
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist