=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346726338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEAGHAN FOSS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2018
-----------------------------------------------------
Last Update Date | 03/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21885 DUNHAM RD STE 7
-----------------------------------------------------
City | CLINTON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48036-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-469-7700
-----------------------------------------------------
Fax | 586-783-8136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58725 BATES RD
-----------------------------------------------------
City | LENOX
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48048-2513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-243-2187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CASE MANAGER
-----------------------------------------------------
Name | MEAGHAN MARIE FOSS
-----------------------------------------------------
Credential | BSW LLBSW
-----------------------------------------------------
Telephone | 586-243-2187
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6802089950
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------