Healthcare Provider Details

I. General information

NPI: 1972568939
Provider Name (Legal Business Name): CELESTE A FORSYTH RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 206
LORAIN OH
44053-1652
US

IV. Provider business mailing address

3600 KOLBE RD STE 206
LORAIN OH
44053-1652
US

V. Phone/Fax

Practice location:
  • Phone: 440-222-4180
  • Fax: 440-222-4181
Mailing address:
  • Phone: 440-222-4180
  • Fax: 440-222-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: