Provider Demographics
NPI:1023201498
Name:FOSTER-JOHNSON, HEIDI ANN (LISW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ANN
Last Name:FOSTER-JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:OH
Mailing Address - Zip Code:43517-9600
Mailing Address - Country:US
Mailing Address - Phone:419-298-2321
Mailing Address - Fax:419-298-2512
Practice Address - Street 1:328 W VINE ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:OH
Practice Address - Zip Code:43517-9600
Practice Address - Country:US
Practice Address - Phone:419-298-2321
Practice Address - Fax:419-298-2512
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-81401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHFOSW22132Medicare Oscar/Certification