MEDICARE: MS. BOBBI ANNE FOSBURG 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	8274828-3502	UT

General Provider Information

NPI Number	:	1558640276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BOBBI ANNE FOSBURG LCSW

Provider Business Mailing Address
First Line	:	5944 MARKET ST APT H
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7979
Country	:	US
Telephone Number	:	435-640-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 RASMUSSEN RD STE 170
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5519
Country	:	US
Telephone Number	:	435-640-3420
Fax Number	:

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

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	01/18/2026

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