Provider Demographics
NPI:1497905137
Name:FORRESTER, ALLISON RENEE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 IVANHOE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1438
Mailing Address - Country:US
Mailing Address - Phone:502-451-9321
Mailing Address - Fax:
Practice Address - Street 1:1910 IVANHOE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1438
Practice Address - Country:US
Practice Address - Phone:502-451-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist