Healthcare Provider Details

I. General information

NPI: 1568376085
Provider Name (Legal Business Name): MARY LYNN FORSTNER MS/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 6TH ST
FRIENDSHIP WI
53934-9135
US

IV. Provider business mailing address

265 GENEVA TRL APT 401
NEKOOSA WI
54457-8614
US

V. Phone/Fax

Practice location:
  • Phone: 608-339-3213
  • Fax:
Mailing address:
  • Phone: 920-636-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: