Basic Information
| Provider Information | |||||||||
| NPI: | 1922249853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4102 PINION DR | ||||||||
| Address2: | |||||||||
| City: | UNITED STATES AIR FORCE ACAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808402502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193335177 | ||||||||
| FaxNumber: | 7193336900 | ||||||||
| Practice Location | |||||||||
| Address1: | 4102 PINION DR | ||||||||
| Address2: | |||||||||
| City: | UNITED STATES AIR FORCE ACAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808402502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193335177 | ||||||||
| FaxNumber: | 7193336900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | 6801089428 | MI | Y | Other Service Providers | Military Health Care Provider |
No ID Information.