Healthcare Provider Details

I. General information

NPI: 1881507143
Provider Name (Legal Business Name): VANESSA MARIE FORISTER PLBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 ARBOR SPRING DR
BALLWIN MO
63021-7489
US

IV. Provider business mailing address

12902 HIGHWAY TT
FESTUS MO
63028-4347
US

V. Phone/Fax

Practice location:
  • Phone: 573-203-3699
  • Fax:
Mailing address:
  • Phone: 636-543-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026044558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: