Provider Demographics
NPI:1770037061
Name:FORD, CHARLOTTE
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
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 1:67 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-4308
Mailing Address - Country:US
Mailing Address - Phone:267-886-4480
Mailing Address - Fax:
Practice Address - Street 1:169 S RIVER RD UNIT 9
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6934
Practice Address - Country:US
Practice Address - Phone:603-296-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist