MEDICARE: DR. TAWNYA S FOSTER PSYD

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	103TC0700X	Clinical Psychologist	5605	OH

General Provider Information

NPI Number	:	1588733174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAWNYA S FOSTER PSYD

Provider Business Mailing Address
First Line	:	11 W COOKE RD
Second Line	:	SUITE 6
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3068
Country	:	US
Telephone Number	:	614-947-0918
Fax Number	:	614-564-9416

Provider Business Practice Location Address
First Line	:	4949 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214
Country	:	US
Telephone Number	:	614-451-6606
Fax Number	:	614-451-2923

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	01/09/2010

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