Basic Information
| Provider Information | |||||||||
| NPI: | 1730351842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORSBERG | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 S BROOK LN | ||||||||
| Address2: | |||||||||
| City: | CARBONDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629012302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185496773 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 N. WALNUT | ||||||||
| Address2: | PINCKNEYVILLE COMMUNITY HOSPITAL | ||||||||
| City: | PINCKNEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622741034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183572187 | ||||||||
| FaxNumber: | 6183576336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2008 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146004765 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.