Provider Demographics
NPI:1518272624
Name:FORTE, COLEEN JO (LPN)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:JO
Last Name:FORTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W WABASH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5073
Mailing Address - Country:US
Mailing Address - Phone:610-504-1802
Mailing Address - Fax:
Practice Address - Street 1:136 N FRONT ST
Practice Address - Street 2:
Practice Address - City:COPLAY
Practice Address - State:PA
Practice Address - Zip Code:18037-1218
Practice Address - Country:US
Practice Address - Phone:610-262-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN082568L320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities