Healthcare Provider Details

I. General information

NPI: 1508786864
Provider Name (Legal Business Name): JASMINE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 N 11TH ST
MILWAUKEE WI
53206-2831
US

IV. Provider business mailing address

3307 N 11TH ST
MILWAUKEE WI
53206-2831
US

V. Phone/Fax

Practice location:
  • Phone: 262-409-8087
  • Fax:
Mailing address:
  • Phone: 262-409-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: