Healthcare Provider Details

I. General information

NPI: 1952692071
Provider Name (Legal Business Name): MEGAN FOSTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN PETERSON

II. Dates (important events)

Enumeration Date: 04/23/2011
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 JESSICA LN
RAYTOWN MO
64138-2639
US

IV. Provider business mailing address

2500 W UTOPIA RD STE 100
PHOENIX AZ
85027-4172
US

V. Phone/Fax

Practice location:
  • Phone: 816-358-3535
  • Fax:
Mailing address:
  • Phone: 623-683-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-17803
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010040962
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: