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General NPI Number Information
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NPI Number | 1942446331
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Entity Type | Individual
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Provider Name | ANNA KRISTEN FORD LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 24760 HOSPITAL DRIVE
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City | RED LAKE
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State | MN
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Zip | 56671-0249
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Country | US
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Telephone | 218-679-3316
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Fax | 218-679-3990
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Provider Business Mailing Address
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Address Line | 24760 HOSPITAL DR PO BOX 249
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City | RED LAKE
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State | MN
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Zip | 56671
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Country | US
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Telephone | 218-679-3316
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Fax | 218-679-3990
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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 | 17618
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License Number State | MN
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