Provider Demographics
NPI:1982153235
Name:FORD, CALLI (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CALLI
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CALLI
Other - Middle Name:J
Other - Last Name:HANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2025 W PARK PL STE B
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2787
Mailing Address - Country:US
Mailing Address - Phone:208-620-5210
Mailing Address - Fax:208-664-5346
Practice Address - Street 1:925 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9049
Practice Address - Country:US
Practice Address - Phone:208-618-0787
Practice Address - Fax:208-625-5641
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker