| Doctor Name: | JERI ANN FORREST |
| NPI Number: | 1013169275 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 34005624A |
| Business Practice Address: | 1818 Carew St Suite 230 Fort Wayne, IN - 468054788 |
| Business Phone Number: | 2603738000 |
| Business Fax Number: | 2603738003 |
| Mailing Address: | 2020 River Run Trl, Apt. D FORT WAYNE |
| State: | IN |
| Postal Code: | 468256080 |
| Phone Number: | 2605154575 |
| Fax Number: | |
| NPI Enumeration Date: | 10/21/2008 |
| NPI Last Update Date: | 07/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 34005624A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |