Provider Demographics
NPI:1215447453
Name:FOSTER, MAGGIE ANNE (MED)
Entity type:Individual
Prefix:PROF
First Name:MAGGIE
Middle Name:ANNE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:112 W MUSKEGON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1538
Mailing Address - Country:US
Mailing Address - Phone:231-220-2331
Mailing Address - Fax:
Practice Address - Street 1:12330 JAMES ST STE B20
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8575
Practice Address - Country:US
Practice Address - Phone:231-220-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst