Provider Demographics
NPI:1689698854
Name:FORRESTER, PAULA MICHELLE (MED)
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:MICHELLE
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KOPAY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3512
Mailing Address - Country:US
Mailing Address - Phone:706-494-1601
Mailing Address - Fax:
Practice Address - Street 1:125 CREEKVIEW TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7229
Practice Address - Country:US
Practice Address - Phone:706-575-0118
Practice Address - Fax:866-464-6131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist