Provider Demographics
NPI:1710201942
Name:FORRESTER, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FORRESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, IBCLC, RLC
Mailing Address - Street 1:31 SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2737
Mailing Address - Country:US
Mailing Address - Phone:860-978-4850
Mailing Address - Fax:866-874-3198
Practice Address - Street 1:485 NEW PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1333
Practice Address - Country:US
Practice Address - Phone:860-255-8583
Practice Address - Fax:866-874-3198
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN