Provider Demographics
NPI:1568596591
Name:FORSTER, ANTONIA (PHD)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:FORSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5440 SW WESTGATE DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2420
Mailing Address - Country:US
Mailing Address - Phone:971-998-7489
Mailing Address - Fax:503-297-5744
Practice Address - Street 1:5440 SW WESTGATE DR
Practice Address - Street 2:SUITE 175
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2420
Practice Address - Country:US
Practice Address - Phone:971-998-7489
Practice Address - Fax:503-297-5744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR667103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist