Healthcare Provider Details

I. General information

NPI: 1538316153
Provider Name (Legal Business Name): KATHRYN E FORBES B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17212 N SCOTTSDALE RD APT 3339
SCOTTSDALE AZ
85255-9665
US

IV. Provider business mailing address

17212 N SCOTTSDALE RD APT 3339
SCOTTSDALE AZ
85255-9665
US

V. Phone/Fax

Practice location:
  • Phone: 208-860-5391
  • Fax:
Mailing address:
  • Phone: 208-860-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPL5952
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: