Healthcare Provider Details

I. General information

NPI: 1710201942
Provider Name (Legal Business Name): SUSAN FORRESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN FORRESTER MA, IBCLC, RLC

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE STE 304
FARMINGTON CT
06032-1952
US

IV. Provider business mailing address

31 SUNSET TER
WEST HARTFORD CT
06107-2737
US

V. Phone/Fax

Practice location:
  • Phone: 860-255-8583
  • Fax: 866-874-3198
Mailing address:
  • Phone: 860-978-4850
  • Fax: 866-874-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: