Provider Demographics
NPI:1760289888
Name:FORSBERG, KELLEY LAURYN
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:LAURYN
Last Name:FORSBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 KYLE RD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-9310
Mailing Address - Country:US
Mailing Address - Phone:509-780-7875
Mailing Address - Fax:
Practice Address - Street 1:921 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5662
Practice Address - Country:US
Practice Address - Phone:509-780-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61651802101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)