Provider Demographics
NPI:1629291141
Name:FORBES, PHYLLIS S (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:S
Last Name:FORBES
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:155 LAKEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2726
Mailing Address - Country:US
Mailing Address - Phone:802-860-6606
Mailing Address - Fax:
Practice Address - Street 1:POMEROY HALL 489 MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-0001
Practice Address - Country:US
Practice Address - Phone:802-656-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT12095059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist