1770094708 NPI number — MCKAYLA FORSBERG

Table of content: MCKAYLA FORSBERG (NPI 1770094708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770094708 NPI number — MCKAYLA FORSBERG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORSBERG
Provider First Name:
MCKAYLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770094708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 HAYS ST.
Provider Second Line Business Mailing Address:
PO BOX 304
Provider Business Mailing Address City Name:
ASOTIN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-254-3264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 HAYS ST
Provider Second Line Business Practice Location Address:
PO BOX 304
Provider Business Practice Location Address City Name:
ASOTIN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-254-3264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LW61246792 . This is a "WASHINGTON LICENSED CLINICAL SOCIAL WORKER LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: L10677 . This is a "OREGON LICENSED CLINICAL SOCIAL WORKER LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 500770369 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com