Provider Demographics
NPI:1447219399
Name:FORD, DEBBRA ANN (LP)
Entity Type:Individual
Prefix:
First Name:DEBBRA
Middle Name:ANN
Last Name:FORD
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 WILLSON RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1332
Mailing Address - Country:US
Mailing Address - Phone:952-927-8528
Mailing Address - Fax:612-929-2327
Practice Address - Street 1:5200 WILLSON RD
Practice Address - Street 2:SUITE 309
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1332
Practice Address - Country:US
Practice Address - Phone:952-927-8528
Practice Address - Fax:612-929-2327
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2846103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN19Q19FOOtherBC/BS INDIVIDUAL PROVIDER