Healthcare Provider Details

I. General information

NPI: 1538935994
Provider Name (Legal Business Name): JESSICA L FORD CHILD CARE PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 S 16TH ST
MILWAUKEE WI
53215-2617
US

IV. Provider business mailing address

2161 S 16TH ST
MILWAUKEE WI
53215-2617
US

V. Phone/Fax

Practice location:
  • Phone: 414-722-1710
  • Fax:
Mailing address:
  • Phone: 414-722-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberWI031262101193
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: