Provider Demographics
NPI:1861365967
Name:FORD, TRICIA LOUISE
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LOUISE
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 1:5750 FALLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7147
Mailing Address - Country:US
Mailing Address - Phone:260-204-5719
Mailing Address - Fax:
Practice Address - Street 1:5750 FALLS DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7147
Practice Address - Country:US
Practice Address - Phone:260-204-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician