Provider Demographics
NPI:1821573882
Name:FORD, WAYNE STEVEN
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:STEVEN
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 1:1765 WILLIAMS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3542
Mailing Address - Country:US
Mailing Address - Phone:567-208-7457
Mailing Address - Fax:
Practice Address - Street 1:1765 WILLIAMS AVE # 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3542
Practice Address - Country:US
Practice Address - Phone:567-208-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health