Healthcare Provider Details

I. General information

NPI: 1972828978
Provider Name (Legal Business Name): LESLIE FOSTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SHARE DR
ALVA OK
73717-3616
US

IV. Provider business mailing address

730 SHARE DR
ALVA OK
73717-3616
US

V. Phone/Fax

Practice location:
  • Phone: 580-609-3413
  • Fax:
Mailing address:
  • Phone: 580-609-3413
  • Fax: 580-609-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5403
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: