Provider Demographics
NPI:1942885496
Name:FORD, JOLENE ANN
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:ANN
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 1:420 S HENRY ST
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4515
Mailing Address - Country:US
Mailing Address - Phone:605-494-1500
Mailing Address - Fax:605-494-1501
Practice Address - Street 1:610 W 23RD ST STE 2B
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1209
Practice Address - Country:US
Practice Address - Phone:605-494-1500
Practice Address - Fax:605-494-1501
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor