Healthcare Provider Details

I. General information

NPI: 1114530938
Provider Name (Legal Business Name): SUANNE GRACE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3762 HIGHWAY 15
MANGHAM LA
71259-5190
US

IV. Provider business mailing address

PO BOX 192
ARCHIBALD LA
71218-0192
US

V. Phone/Fax

Practice location:
  • Phone: 318-547-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18070
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: