Provider Demographics
NPI:1568611309
Name:FORRESTER, KERI ELIZABETH
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ELIZABETH
Last Name:FORRESTER
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 1:1022 JONES RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0939
Mailing Address - Country:US
Mailing Address - Phone:479-310-6505
Mailing Address - Fax:479-763-0059
Practice Address - Street 1:1022 JONES RD STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762
Practice Address - Country:US
Practice Address - Phone:479-310-6505
Practice Address - Fax:479-763-0059
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
1-18-29652103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor