Provider Demographics
NPI:1962696997
Name:LAFOREST, ERIKA KRISTI (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:KRISTI
Last Name:LAFOREST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 E CORTLAND BLVD
Mailing Address - Street 2:APT#292
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2516
Mailing Address - Country:US
Mailing Address - Phone:928-266-0967
Mailing Address - Fax:
Practice Address - Street 1:3036 N BOLDT DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0960
Practice Address - Country:US
Practice Address - Phone:928-773-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP2162OtherDEPT OF HEALTH SERVICES