Provider Demographics
NPI:1568444511
Name:FOSTER, DALE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:S
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 WALNUT KNOLL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3112
Mailing Address - Country:US
Mailing Address - Phone:901-624-0100
Mailing Address - Fax:901-624-0778
Practice Address - Street 1:758 WALNUT KNOLL LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3112
Practice Address - Country:US
Practice Address - Phone:901-624-0100
Practice Address - Fax:901-624-0778
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-1439103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685789Medicare ID - Type UnspecifiedCIGNA MEDICARE NUMBER
TN4092260Medicare UPIN