Provider Demographics
NPI:1861719460
Name:FOSKETT, MARY CHRISTINE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINE
Last Name:FOSKETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:M
Other - Middle Name:CHRISTINE
Other - Last Name:FOSKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:N27W23960 PAUL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6218
Mailing Address - Country:US
Mailing Address - Phone:815-520-3141
Mailing Address - Fax:
Practice Address - Street 1:N27W23960 PAUL RD STE 206
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6218
Practice Address - Country:US
Practice Address - Phone:815-520-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3076-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1861719460Medicaid