Provider Demographics
NPI:1891095584
Name:FORD, NICOLE BEVERLY
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BEVERLY
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5055
Mailing Address - Street 2:105 S. GARDEN AVE.
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-5055
Mailing Address - Country:US
Mailing Address - Phone:509-447-5651
Mailing Address - Fax:509-447-5651
Practice Address - Street 1:105 S. GARDEN AVE.
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-5055
Practice Address - Country:US
Practice Address - Phone:509-447-5651
Practice Address - Fax:509-447-5651
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical