Provider Demographics
NPI:1831646314
Name:FOSTER, IAN (BS, MBA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:BS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-1065
Mailing Address - Country:US
Mailing Address - Phone:907-434-1780
Mailing Address - Fax:
Practice Address - Street 1:607 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-1065
Practice Address - Country:US
Practice Address - Phone:907-434-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor