Provider Demographics
NPI:1114040037
Name:FORESTER, DLAINE (MED CCCSP)
Entity Type:Individual
Prefix:MS
First Name:DLAINE
Middle Name:
Last Name:FORESTER
Suffix:
Gender:F
Credentials:MED CCCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15123 FOREST LODGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1216
Mailing Address - Country:US
Mailing Address - Phone:281-376-2805
Mailing Address - Fax:
Practice Address - Street 1:15123 FOREST LODGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1216
Practice Address - Country:US
Practice Address - Phone:281-376-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist