MEDICARE: STEPHANIE FOSTER

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1962702936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE FOSTER

Provider Business Mailing Address
First Line	:	1390 S 1100 E STE 203
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2463
Country	:	US
Telephone Number	:	801-983-5700
Fax Number	:	801-983-5701

Provider Business Practice Location Address
First Line	:	1390 S 1100 E STE 203
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2463
Country	:	US
Telephone Number	:	801-983-5700
Fax Number	:	801-983-5701

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	10/25/2010

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Directions to “ STEPHANIE FOSTER ” Practice Location

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