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NPI Code Detail

MEDICARE: REBECCA A FORNER MA CFY-SLP

MEDICARE: REBECCA A FORNER MA CFY-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist8045MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1657S5FOOTHERMNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1205992559
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA A FORNER MA CFY-SLP
Provider Business Mailing Address
First Line : 11087 ROBINSON DR NW
Second Line : #232
City : COON RAPIDS
State : MN
Zip : 55433-4283
Country : US
Telephone Number : 612-306-1933
Fax Number :
Provider Business Practice Location Address
First Line : 9048 PEONY LN N
Second Line :
City : MAPLE GROVE
State : MN
Zip : 55311-4417
Country : US
Telephone Number : 763-416-9313
Fax Number : 763-416-4530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 07/08/2007

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Directions to “ REBECCA A FORNER MA CFY-SLP” Practice Location

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