Provider Demographics
NPI:1831547231
Name:FOSTER, CASSIE (LSW)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 12TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3511
Mailing Address - Country:US
Mailing Address - Phone:701-456-7675
Mailing Address - Fax:170-145-6777
Practice Address - Street 1:664 12TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3511
Practice Address - Country:US
Practice Address - Phone:701-456-7675
Practice Address - Fax:170-456-7777
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker