Provider Demographics
NPI:1548515562
Name:FORGEY, STEPHANIE ANDREA (LMT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANDREA
Last Name:FORGEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506 W LA REATA AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4659
Mailing Address - Country:US
Mailing Address - Phone:602-619-4140
Mailing Address - Fax:
Practice Address - Street 1:10506 W LA REATA AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4659
Practice Address - Country:US
Practice Address - Phone:602-619-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-09482172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker