Provider Demographics
NPI:1205083417
Name:ANNE J FORD MSW LICSW LLC
Entity type:Organization
Organization Name:ANNE J FORD MSW LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-817-1757
Mailing Address - Street 1:9810 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1755
Mailing Address - Country:US
Mailing Address - Phone:612-817-1757
Mailing Address - Fax:
Practice Address - Street 1:9810 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1755
Practice Address - Country:US
Practice Address - Phone:612-817-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty