Provider Demographics
NPI:1659366532
Name:FORS, SHIRLEY ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:FORS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:FORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:12800 INDUSTRIAL PARK BLVD
Mailing Address - Street 2:#105
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3974
Mailing Address - Country:US
Mailing Address - Phone:763-550-0603
Mailing Address - Fax:763-559-0985
Practice Address - Street 1:12800 INDUSTRIAL PARK BLVD
Practice Address - Street 2:#105
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3974
Practice Address - Country:US
Practice Address - Phone:763-550-0603
Practice Address - Fax:763-559-0985
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5401231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist