Provider Demographics
NPI:1073172995
Name:FORST, ERIC (SLP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:FORST
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 OLD HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2051
Mailing Address - Country:US
Mailing Address - Phone:864-244-3626
Mailing Address - Fax:864-244-6923
Practice Address - Street 1:715 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3135
Practice Address - Country:US
Practice Address - Phone:630-390-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist