Healthcare Provider Details

I. General information

NPI: 1265305841
Provider Name (Legal Business Name): COURTNEY MARIE FOULKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ONEIL RD STE E
HUDSON WI
54016-7084
US

IV. Provider business mailing address

2010 ONEIL RD STE E
HUDSON WI
54016-7084
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-4840
  • Fax:
Mailing address:
  • Phone: 715-246-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8739-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: