Provider Demographics
NPI:1427472976
Name:FORSYTH, JESSICA LAUREN (MS, ATC, CES)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ATC, CES
Mailing Address - Street 1:2030 ENCIMA DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 ENCIMA DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2210
Practice Address - Country:US
Practice Address - Phone:707-349-5199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer