Provider Demographics
NPI:1689117202
Name:DR CHRISTINE FOSKETT LLC
Entity Type:Organization
Organization Name:DR CHRISTINE FOSKETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. OF CLINICAL PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FOSKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-841-1442
Mailing Address - Street 1:N27W23960 PAUL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6218
Mailing Address - Country:US
Mailing Address - Phone:815-520-3141
Mailing Address - Fax:
Practice Address - Street 1:N27W23960 PAUL RD STE 206
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6218
Practice Address - Country:US
Practice Address - Phone:815-520-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3076-57261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)