Provider Demographics
NPI:1154964344
Name:FORSTER, CLARK
Entity type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:FORSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W OAKLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1677
Mailing Address - Country:US
Mailing Address - Phone:304-521-4365
Mailing Address - Fax:
Practice Address - Street 1:1620 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3734
Practice Address - Country:US
Practice Address - Phone:276-451-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist