# MICHELLE MARIE FORD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790940450
- **Authorized official:** MS. LAURA RYAN MED. (SPECIAL SERVICES DIRECTOR)
- **Authorized official phone:** (573) 782-3352

## Contact information

- **Practice address:** 13111 PARK ST, RUSSELLVILLE, MO 65074-1232
- **Practice address phone:** (573) 782-3534
- **Practice address fax:** (573) 782-3435
- **Mailing address:** 13111 PARK ST, RUSSELLVILLE, MO 65074-1232
- **Mailing address phone:** (573) 782-3534
- **Mailing address fax:** (573) 782-3435

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251300000X | Local Education Agency (LEA) | 104884 | MO | Yes |

## Other

- **Enumeration date:** 07/22/2008
- **Last updated:** 08/22/2008