Healthcare Provider Details

I. General information

NPI: 1407768393
Provider Name (Legal Business Name): MACKENZIE JANE FORD MPH, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 KENNEDY ST NW STE 304
WASHINGTON DC
20011-3137
US

IV. Provider business mailing address

1756 HOBART ST NW
WASHINGTON DC
20009-2908
US

V. Phone/Fax

Practice location:
  • Phone: 202-743-4884
  • Fax:
Mailing address:
  • Phone: 206-715-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: