Provider Demographics
NPI:1932930872
Name:FOSTER, SHALA
Entity type:Individual
Prefix:
First Name:SHALA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:CAULFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65626-0014
Mailing Address - Country:US
Mailing Address - Phone:501-206-4555
Mailing Address - Fax:
Practice Address - Street 1:2465 RODEO DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4501
Practice Address - Country:US
Practice Address - Phone:870-425-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist