Provider Demographics
NPI:1548791882
Name:FORREST, BRIANNA D
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:D
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-8166
Mailing Address - Country:US
Mailing Address - Phone:870-952-9075
Mailing Address - Fax:
Practice Address - Street 1:409 W OAK ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2227
Practice Address - Country:US
Practice Address - Phone:870-222-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-01652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217020721Medicaid