MEDICARE: KATHERINE FORSLUND PSYD

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
1	103TC0700X	Clinical Psychologist	1885	SC

General Provider Information

NPI Number	:	1588199962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE FORSLUND PSYD

Provider Business Mailing Address
First Line	:	244 WESSINGER FARMS RD
Second Line	:
City	:	CHAPIN
State	:	SC
Zip	:	29036-9488
Country	:	US
Telephone Number	:	530-708-1275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 ELMWOOD AVE STE 300B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2150
Country	:	US
Telephone Number	:	803-250-5109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	07/29/2024

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