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General NPI Number Information
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NPI Number | 1649134644
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Entity Type | Individual
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Provider Name | KYLE FORD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 329 S LAFAYETTE ST APT 1
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City | MACOMB
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State | IL
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Zip | 61455-2298
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Country | US
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Telephone | 602-471-3119
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Fax |
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Provider Business Mailing Address
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Address Line | 329 S LAFAYETTE ST APT 1
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City | MACOMB
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State | IL
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Zip | 61455-2298
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Country | US
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Telephone | 602-471-3119
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State | IL
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