Healthcare Provider Details

I. General information

NPI: 1821587825
Provider Name (Legal Business Name): YASMINE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E MICHIGAN AVE STE 345
KALAMAZOO MI
49007-6403
US

IV. Provider business mailing address

1343 MANOR ST
KALAMAZOO MI
49006-2143
US

V. Phone/Fax

Practice location:
  • Phone: 269-254-6613
  • Fax: 269-443-2166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801109337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: