Provider Demographics
NPI:1467577429
Name:FORD, JUDITH M (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4230 N OAKLAND AVE
Mailing Address - Street 2:#146
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2042
Mailing Address - Country:US
Mailing Address - Phone:414-324-9227
Mailing Address - Fax:
Practice Address - Street 1:216 N WATER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5762
Practice Address - Country:US
Practice Address - Phone:414-324-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2003-1231041C0700X
WI502-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist