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General NPI Number Information
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NPI Number | 1710044151
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Entity Type | Individual
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Provider Name | WILLIAM N FORD LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 1220 DEWEY AVE LORTON II
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City | WAUWATOSA
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State | WI
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Zip | 53213-2504
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Country | US
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Telephone | 414-454-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 N PROSPECT AVE APT 601
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City | MILWAUKEE
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State | WI
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Zip | 53202-2361
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Country | US
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Telephone | 414-276-2548
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3979-123
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License Number State | WI
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