Provider Demographics
NPI:1336110493
Name:FOSTER, KIM (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
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 1:709 GARBER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2133
Mailing Address - Country:US
Mailing Address - Phone:814-317-7080
Mailing Address - Fax:
Practice Address - Street 1:3701 BURGOON RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1715
Practice Address - Country:US
Practice Address - Phone:814-932-0102
Practice Address - Fax:814-944-0419
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006380L103T00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical