Provider Demographics
NPI:1164470514
Name:FORD, JOEY COLEMAN (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JOEY
Middle Name:COLEMAN
Last Name:FORD
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MRS
Other - First Name:JOEY
Other - Middle Name:LYN
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3764
Mailing Address - Fax:816-234-3291
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3764
Practice Address - Fax:816-234-3291
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001418231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
269B498Medicare ID - Type Unspecified
P47841Medicare UPIN