MEDICARE: TERESA C. HOSKINS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	000972	MO

General Provider Information

NPI Number	:	1164403200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA C. HOSKINS LCSW

Provider Business Mailing Address
First Line	:	1001 W WORLEY ST
Second Line	:	FAMILY HEALTH CENTER
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2037
Country	:	US
Telephone Number	:	573-214-2314
Fax Number	:	573-814-2784

Provider Business Practice Location Address
First Line	:	1001 W WORLEY ST
Second Line	:	FAMILY HEALTH CENTER
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2037
Country	:	US
Telephone Number	:	573-214-2314
Fax Number	:	573-814-2784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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