Provider Demographics
NPI:1487779690
Name:FORD, JAMELIE KATHLEEN III
Entity type:Individual
Prefix:MS
First Name:JAMELIE
Middle Name:KATHLEEN
Last Name:FORD
Suffix:III
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 1:16 163RD PL
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-6002
Mailing Address - Country:US
Mailing Address - Phone:708-933-0724
Mailing Address - Fax:708-795-4800
Practice Address - Street 1:7424 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1279
Practice Address - Country:US
Practice Address - Phone:708-458-8228
Practice Address - Fax:708-458-9177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator