Provider Demographics
NPI:1851865927
Name:FORST, KIMBERLY NORA (BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NORA
Last Name:FORST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 W 99TH PL
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2640
Mailing Address - Country:US
Mailing Address - Phone:630-392-1502
Mailing Address - Fax:
Practice Address - Street 1:16W361 S FRONTAGE RD STE 131
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5816
Practice Address - Country:US
Practice Address - Phone:630-590-5571
Practice Address - Fax:630-590-5731
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst