Provider Demographics
NPI:1518930379
Name:COLE, FOSTER C (PHD LP)
Entity Type:Individual
Prefix:
First Name:FOSTER
Middle Name:C
Last Name:COLE
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:6150 OREN AVE N
Practice Address - Street 2:MAIL CODE 14001A
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6173
Practice Address - Country:US
Practice Address - Phone:651-430-1668
Practice Address - Fax:651-430-0177
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN0228103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN357852600Medicaid
R54553Medicare UPIN
MN680001951Medicare ID - Type Unspecified