Provider Demographics
NPI:1528782398
Name:FOERSTER, NIKKI D
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:D
Last Name:FOERSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11362 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-4325
Mailing Address - Country:US
Mailing Address - Phone:618-943-3302
Mailing Address - Fax:618-943-3657
Practice Address - Street 1:11362 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-4325
Practice Address - Country:US
Practice Address - Phone:618-943-3302
Practice Address - Fax:618-943-3657
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health