Provider Demographics
NPI:1295565505
Name:FORREST, SALLY ANNE
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 GOODSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-9410
Mailing Address - Country:US
Mailing Address - Phone:614-736-0261
Mailing Address - Fax:
Practice Address - Street 1:5355 GOODSON RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-9410
Practice Address - Country:US
Practice Address - Phone:614-736-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant