Provider Demographics
NPI:1982380507
Name:FOSTER, SAMANTHA LOUISE (MS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LOUISE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:IA
Mailing Address - Zip Code:50524-7613
Mailing Address - Country:US
Mailing Address - Phone:515-570-3211
Mailing Address - Fax:
Practice Address - Street 1:211 AVENUE M W
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5789
Practice Address - Country:US
Practice Address - Phone:515-576-7261
Practice Address - Fax:515-955-7652
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)