Provider Demographics
NPI:1801090600
Name:FORD, MAURA PATRICE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MAURA
Middle Name:PATRICE
Last Name:FORD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 SANDYFORD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-4413
Mailing Address - Country:US
Mailing Address - Phone:215-219-4325
Mailing Address - Fax:
Practice Address - Street 1:2814 SANDYFORD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-4413
Practice Address - Country:US
Practice Address - Phone:215-219-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist