Provider Demographics
NPI:1326513599
Name:FORD, SHAWANDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHAWANDA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W BROWN DEER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2346
Mailing Address - Country:US
Mailing Address - Phone:414-446-8154
Mailing Address - Fax:
Practice Address - Street 1:5600 W BROWN DEER RD STE 106
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2346
Practice Address - Country:US
Practice Address - Phone:414-446-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3811-226Medicaid