Healthcare Provider Details

I. General information

NPI: 1730710450
Provider Name (Legal Business Name): ALWYN FOSTER LPC-IT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4706 COTTAGE GROVE RD, SUITE 100,
MADISON WI
53716
US

IV. Provider business mailing address

4706 COTTAGE GROVE RD STE 100
MADISON WI
53716-1354
US

V. Phone/Fax

Practice location:
  • Phone: 608-268-6530
  • Fax: 608-709-1744
Mailing address:
  • Phone: 715-842-9500
  • Fax: 715-848-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8635-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: