Basic Information
| Provider Information | |||||||||
| NPI: | 1356364590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORREST | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HUGHES | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | KERSCHNER | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3240 WASHINGTON RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MCMURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249414434 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3240 WASHINGTON RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MCMURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249414434 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL003906 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1010180940001 | 05 | PA | MEDICAID |