Healthcare Provider Details

I. General information

NPI: 1013503119
Provider Name (Legal Business Name): ANNA MARGARET FORD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE FORD MT-BC

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date: 08/08/2022
Reactivation Date: 10/19/2022

III. Provider practice location address

1905 CHERRY HILL DR STE 102
COLUMBIA MO
65203-5920
US

IV. Provider business mailing address

3601 W BROADWAY APT 10203
COLUMBIA MO
65203-7909
US

V. Phone/Fax

Practice location:
  • Phone: 573-303-5772
  • Fax:
Mailing address:
  • Phone: 606-584-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number15984
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: