Provider Demographics
NPI:1245421700
Name:FOSTER, SHALA D (LMSW)
Entity Type:Individual
Prefix:
First Name:SHALA
Middle Name:D
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2003
Mailing Address - Country:US
Mailing Address - Phone:316-262-2060
Mailing Address - Fax:316-262-2740
Practice Address - Street 1:247 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2003
Practice Address - Country:US
Practice Address - Phone:316-262-2060
Practice Address - Fax:316-262-2740
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6710104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker