Provider Demographics
NPI:1013503119
Name:FORD, ANNA MARGARET (MT-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARGARET
Last Name:FORD
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:3601 W BROADWAY APT 10203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7909
Mailing Address - Country:US
Mailing Address - Phone:606-584-2608
Mailing Address - Fax:
Practice Address - Street 1:1905 CHERRY HILL DR STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5920
Practice Address - Country:US
Practice Address - Phone:573-303-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2022-10-19
Deactivation Date:2022-08-08
Deactivation Code:
Reactivation Date:2022-10-19
Provider Licenses
StateLicense IDTaxonomies
MO15984225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist