Provider Demographics
NPI:1982398715
Name:FOSTER, SIERRA RUSSELL (BCBA)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:RUSSELL
Last Name:FOSTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5732
Mailing Address - Country:US
Mailing Address - Phone:970-238-1122
Mailing Address - Fax:
Practice Address - Street 1:135 BURNETT DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7790
Practice Address - Country:US
Practice Address - Phone:970-769-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-23-65806103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst