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General NPI Number Information
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NPI Number | 1104297100
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Entity Type | Organization
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Legal Business Name | MAUREEN R FORD, PHD, PC
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1225
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-860-0708
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Fax | 312-255-7115
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST SUITE 1225
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-860-0708
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Fax | 312-255-7115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAUREEN R FORD
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Credential | PHD
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Telephone | 312-860-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071003720
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License Number State | IL
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