Provider Demographics
NPI:1598070153
Name:FORD, CONSTANCE LYNN (EDD,SLP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:LYNN
Last Name:FORD
Suffix:
Gender:F
Credentials:EDD,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5768 EDISON CIR
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5334
Mailing Address - Country:US
Mailing Address - Phone:630-205-1452
Mailing Address - Fax:
Practice Address - Street 1:5768 EDISON CIR
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5334
Practice Address - Country:US
Practice Address - Phone:630-205-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.001169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist