Provider Demographics
NPI:1366280257
Name:FOSTER, KELLY (MA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3900
Mailing Address - Country:US
Mailing Address - Phone:763-337-3252
Mailing Address - Fax:
Practice Address - Street 1:1414 S OAK AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3900
Practice Address - Country:US
Practice Address - Phone:763-337-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty