Organization
FOREST ACADEMY
Active
Organization
FOREST ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRETCHEN SHISSLER MOTR/L (EXECUTIVE DIRECTOR)
(765) 414-0125
Entity
Organization
Contact information
Practice address
8439 STATE ROAD 26 E, LAFAYETTE, IN 47905-9519
(765) 414-0125
Mailing address
44 JESTER CT, LAFAYETTE, IN 47905-7608
(765) 414-0125
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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