Healthcare Provider Details
I. General information
NPI: 1821494923
Provider Name (Legal Business Name): KATIE J FOSTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/17/2014
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US
IV. Provider business mailing address
W175N11120 STONEWOOD DR
GERMANTOWN WI
53022-6511
US
V. Phone/Fax
- Phone: 262-999-3495
- Fax:
- Phone: 262-345-5560
- Fax: 262-293-9737
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 2449-226 |
| License Number State | WI |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 17655-130 |
| License Number State | WI |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 6445-125 |
| License Number State | WI |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: