Healthcare Provider Details

I. General information

NPI: 1215365077
Provider Name (Legal Business Name): SUSAN FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

IV. Provider business mailing address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-5000
  • Fax: 270-842-5268
Mailing address:
  • Phone: 270-901-5000
  • Fax: 270-842-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6762
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: