Provider Demographics
NPI:1275835464
Name:FORD, NATASHA RAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:RAE
Last Name:FORD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1102
Mailing Address - Country:US
Mailing Address - Phone:606-305-3569
Mailing Address - Fax:
Practice Address - Street 1:120 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1102
Practice Address - Country:US
Practice Address - Phone:606-305-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10-020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist