Provider Demographics
NPI:1366845570
Name:FORESTAL, KELLY (BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:FORESTAL
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9529 NOAK CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8515
Mailing Address - Country:US
Mailing Address - Phone:907-350-8893
Mailing Address - Fax:907-302-3408
Practice Address - Street 1:16331 HERITAGE PL STE 101
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7753
Practice Address - Country:US
Practice Address - Phone:907-350-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst