Provider Demographics
NPI:1699854315
Name:FORBES, CAROL JANE (SPPA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JANE
Last Name:FORBES
Suffix:
Gender:F
Credentials:SPPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MODOC ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4838
Mailing Address - Country:US
Mailing Address - Phone:530-251-5775
Mailing Address - Fax:530-251-5775
Practice Address - Street 1:1101 MODOC ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4838
Practice Address - Country:US
Practice Address - Phone:530-251-5775
Practice Address - Fax:530-251-5775
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP0039240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist