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General NPI Number Information
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NPI Number | 1396227567
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Entity Type | Individual
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Provider Name | MRS. JAMA LYN FORD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 4792 MASONS RIDGE RD
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City | LAFAYETTE
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State | IN
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Zip | 47909-8425
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Country | US
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Telephone | 765-412-2797
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Fax |
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Provider Business Mailing Address
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Address Line | 4792 MASONS RIDGE RD
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City | LAFAYETTE
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State | IN
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Zip | 47909-8425
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Country | US
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Telephone | 765-412-2797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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