Provider Demographics
NPI:1013508746
Name:LA FOREST, KACIE
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:LA FOREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:CLAUDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 SAN PABLO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5313
Mailing Address - Country:US
Mailing Address - Phone:602-317-3917
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:602-317-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist