Healthcare Provider Details

I. General information

NPI: 1487366811
Provider Name (Legal Business Name): KATHRYN D FORST MA, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 FOXPOINTE DR
SYCAMORE IL
60178-3290
US

IV. Provider business mailing address

PO BOX 1109
DEKALB IL
60115-7109
US

V. Phone/Fax

Practice location:
  • Phone: 815-748-8334
  • Fax:
Mailing address:
  • Phone: 815-756-4875
  • Fax: 815-756-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.131970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: