Provider Demographics
NPI:1821648304
Name:FOSTER, VICKEY (LBA)
Entity Type:Individual
Prefix:
First Name:VICKEY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SW TOMMY ARMOUR LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0319
Mailing Address - Country:US
Mailing Address - Phone:503-568-5949
Mailing Address - Fax:
Practice Address - Street 1:2421 NE DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7111
Practice Address - Country:US
Practice Address - Phone:541-224-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-AB-10213790106E00000X
106S00000X
ORABA-B-10216053103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician