Provider Demographics
NPI:1750471884
Name:FOREST, ANNA BELLE STODDARD (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA BELLE
Middle Name:STODDARD
Last Name:FOREST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANNA BELLE
Other - Middle Name:
Other - Last Name:MCGONAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:123 CHESTERBOOK LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:860-919-0732
Mailing Address - Fax:
Practice Address - Street 1:222 AUBURN ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6004
Practice Address - Country:US
Practice Address - Phone:207-797-8255
Practice Address - Fax:207-797-5560
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6885235Z00000X
MEST1692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432352099Medicaid