Doctor Name: | KATHLEEN KELLY FORKER |
NPI Number: | 1932453362 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A, SLP |
License Number: | 1606015 |
Business Practice Address: | 1287 Newsome St Mount Airy, NC - 270305439 |
Business Phone Number: | 4135391313 |
Business Fax Number: | |
Mailing Address: | 1115 W Bessemer Ave, Apt E GREENSBORO |
State: | NC |
Postal Code: | 274088451 |
Phone Number: | 4135391313 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2012 |
NPI Last Update Date: | 10/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1606015 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |