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General NPI Number Information
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NPI Number | 1205083417
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Entity Type | Organization
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Legal Business Name | ANNE J FORD MSW LICSW LLC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 9810 EDGEWOOD RD
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City | BLOOMINGTON
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State | MN
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Zip | 55438-1755
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Country | US
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Telephone | 612-817-1757
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Fax |
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Provider Business Mailing Address
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Address Line | 9810 EDGEWOOD RD
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City | BLOOMINGTON
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State | MN
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Zip | 55438-1755
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Country | US
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Telephone | 612-817-1757
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ANNE JUDITH FORD
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Credential | LICSW
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Telephone | 612-817-1757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10268
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License Number State | MN
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