Provider Demographics
NPI:1669919775
Name:FOSTER, DONELLA
Entity type:Individual
Prefix:
First Name:DONELLA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S STAR LAKE RD
Mailing Address - Street 2:BLDG. 16 APT #203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3406
Mailing Address - Country:US
Mailing Address - Phone:425-496-4970
Mailing Address - Fax:
Practice Address - Street 1:2211 S STAR LAKE RD
Practice Address - Street 2:BLDG. 16 APT #203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-3406
Practice Address - Country:US
Practice Address - Phone:425-496-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFOSTEDR098BK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician