Individual
MR. TRAVIS JON FORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
903 2ND ST, WAUSAU, WI 54403-4705
(715) 842-3346
(715) 842-3344
Mailing address
903 2ND ST, WAUSAU, WI 54403-4705
(715) 842-3346
(715) 842-3344
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6815-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39795200
—
WI
Enumeration date
05/21/2008
Last updated
05/21/2008
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