MEDICARE: RYAN FORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235500000X	Speech/Language/Hearing Specialist/Technologist	2102002776	VA
2	237700000X	Hearing Instrument Specialist	2101002190	VA

General Provider Information

NPI Number	:	1639552805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN FORD

Provider Business Mailing Address
First Line	:	1013 WORMLEY CREEK DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-4243
Country	:	US
Telephone Number	:	757-617-6170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 WORMLEY CREEK DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-4243
Country	:	US
Telephone Number	:	757-617-6170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2015
Last Update Date	:	08/15/2019

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Directions to “ RYAN FORD ” Practice Location

Language	Start Address	Practice Location

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