Provider Demographics
NPI:1457090524
Name:FOSTER, MELISSA KATHLEEN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHLEEN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KATHLEEN
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:3128 58TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3222
Mailing Address - Country:US
Mailing Address - Phone:206-604-6234
Mailing Address - Fax:
Practice Address - Street 1:1003 S 5TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4210
Practice Address - Country:US
Practice Address - Phone:253-403-2506
Practice Address - Fax:253-403-3555
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601866991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60186699OtherWA DEPARTMENT OF HEALTH