Provider Demographics
NPI:1295130201
Name:FORBES, VANESSA (AUD)
Entity type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:
Last Name:FORBES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 TERRY RD
Mailing Address - Street 2:STE A
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5031
Mailing Address - Country:US
Mailing Address - Phone:631-656-6545
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2900
Practice Address - Country:US
Practice Address - Phone:631-656-6545
Practice Address - Fax:631-265-3733
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000041955231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist