Healthcare Provider Details

I. General information

NPI: 1528975695
Provider Name (Legal Business Name): KATELYN FORREST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 N 68TH ST
MILWAUKEE WI
53218-2901
US

IV. Provider business mailing address

2922 E VOGEL AVE
CUDAHY WI
53110-1832
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-4514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001029746
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: