Larita Goforth, SLP

Individual provider Active NPI Speech-Language Pathologist · Forest, MS

NPI 1205129889 · NPPES record last updated Dec 11, 2018

Key facts

NPI
1205129889
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
S2941 (MS)
Practice address
1129 Highway 35 S Ste 2
Forest, MS 39074-8829
Phone
(601) 469-1001
NPI assigned
May 16, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X S2941 MS Yes

Addresses

Primary practice location

1129 Highway 35 S Ste 2
Forest, MS 39074-8829

Mailing address

4109 Highway 98 W
Summit, MS 39666-9132

Other providers in Forest, MS

All providers in Forest, MS · Speech-Language Pathologist in Mississippi

Sources for this page

Verify at the official NPI Registry.