MEDICARE: MS. ORA GWENDOLYN FOSTER 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	1509C	AL

General Provider Information

NPI Number	:	1023344629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ORA GWENDOLYN FOSTER LCSW

Provider Business Mailing Address
First Line	:	301 14TH ST NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3155
Country	:	US
Telephone Number	:	256-845-4571
Fax Number	:	256-845-4582

Provider Business Practice Location Address
First Line	:	301 14TH ST NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3155
Country	:	US
Telephone Number	:	256-845-4571
Fax Number	:	256-845-4582

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

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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