Provider Demographics
NPI:1053453811
Name:FORESTIERI, GRACE (MS, CCC-SLP, ATP)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:FORESTIERI
Suffix:
Gender:F
Credentials:MS, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DANIEL WAY
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3054
Mailing Address - Country:US
Mailing Address - Phone:631-689-5871
Mailing Address - Fax:
Practice Address - Street 1:45 CROSSWAYS EAST ROAD
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:631-218-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist