Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4537 | OH |
NPI | 1023076114 |
---|---|
Provider Name | Dr. Sandra Waddill Foster |
First Address | Cortland, OH 44410-1450 |
Second Address | Cortland, OH 44410-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 26/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R72003 | (02) | OH |