Provider Demographics
NPI:1023076114
Name:FOSTER, SANDRA WADDILL (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:WADDILL
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1450
Mailing Address - Country:US
Mailing Address - Phone:330-638-6121
Mailing Address - Fax:330-638-7088
Practice Address - Street 1:151 S HIGH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1450
Practice Address - Country:US
Practice Address - Phone:330-638-6121
Practice Address - Fax:330-638-7088
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4537103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHR72003Medicare UPIN
OHFOCP11767Medicare ID - Type Unspecified