Provider Demographics
NPI:1790033793
Name:FORD, DENISE GENEVIEVE SANTOS (CCC - SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:GENEVIEVE SANTOS
Last Name:FORD
Suffix:
Gender:F
Credentials:CCC - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 REDWOOD HWY FRONTAGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1660
Mailing Address - Country:US
Mailing Address - Phone:415-924-2444
Mailing Address - Fax:415-924-2442
Practice Address - Street 1:1058 REDWOOD HWY FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1660
Practice Address - Country:US
Practice Address - Phone:415-924-2444
Practice Address - Fax:415-924-2442
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist