Healthcare Provider Details

I. General information

NPI: 1790022838
Provider Name (Legal Business Name): MRS. ERIN ELIZABETH FORNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE 65TH AVE
VANCOUVER WA
98661-6812
US

IV. Provider business mailing address

7070 N UNIVERSITY AVE
PORTLAND OR
97203-4757
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-7500
  • Fax: 360-906-1010
Mailing address:
  • Phone: 360-510-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: