Provider Demographics
NPI:1427596766
Name:FORD, GORDAN
Entity Type:Individual
Prefix:
First Name:GORDAN
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAMBLING
Mailing Address - State:LA
Mailing Address - Zip Code:71245-3001
Mailing Address - Country:US
Mailing Address - Phone:318-247-6153
Mailing Address - Fax:318-274-3215
Practice Address - Street 1:407 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GRAMBLING
Practice Address - State:LA
Practice Address - Zip Code:71245-3001
Practice Address - Country:US
Practice Address - Phone:318-247-6153
Practice Address - Fax:318-274-3215
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist