Organization
MICHELLE MARIE FORD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA RYAN MED. (SPECIAL SERVICES DIRECTOR)
(573) 782-3352
Entity
Organization
Contact information
Practice address
13111 PARK ST, RUSSELLVILLE, MO 65074-1232
(573) 782-3534
(573) 782-3435
Mailing address
13111 PARK ST, RUSSELLVILLE, MO 65074-1232
(573) 782-3534
(573) 782-3435
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
104884
MO
Other
Enumeration date
07/22/2008
Last updated
08/22/2008
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