Provider Demographics
NPI:1598876401
Name:FOSTER, SANDRA B (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:B
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:B
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW PC
Mailing Address - Street 1:555 EAST 4500 SOUTH #C150
Mailing Address - Street 2:CO SH MANAGEMENT
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-288-0747
Mailing Address - Fax:801-288-0761
Practice Address - Street 1:6925 SO UNION PARK CENTER #490
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-566-2622
Practice Address - Fax:801-566-0536
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138389 3501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker