Provider Demographics
NPI:1932458114
Name:CRAWFORD FOSTER, REBECCA RENAE (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RENAE
Last Name:CRAWFORD FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SOLDIER CREEK CIRCLE
Mailing Address - Street 2:ROSEBUD IHS HOSPITAL
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2311
Mailing Address - Fax:
Practice Address - Street 1:400 SOLDIER CREEK CIRCLE
Practice Address - Street 2:ROSEBUD IHS HOSPITAL
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-2311
Practice Address - Fax:605-747-5092
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1413101YP2500X
SD7121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional