| Jean D Ballou Pc | |
|
210 N Higgins Ave Ste 314 Missoula MT 59802-4443 | |
| (406) 543-9566 | |
| Not Available |
| Full Name | Jean D Ballou Pc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 210 N Higgins Ave Ste 314, Missoula, Montana |
| Authorized Official Name and Position | Jean D Ballou (OWNER) |
| Authorized Official Contact | 4065439566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jean D Ballou Pc 210 N Higgins Ave Ste 314 Missoula MT 59802-4443 Ph: (406) 543-9566 | Jean D Ballou Pc 210 N Higgins Ave Ste 314 Missoula MT 59802-4443 Ph: (406) 543-9566 |
| NPI Number | 1578834586 |
|---|---|
| Provider Enumeration Date | 01/23/2012 |
| Last Update Date | 07/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578834586 | NPI | - | NPPES |
| 0503295 | Medicaid | MT | |
| 0000071350 | Other | MT | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 27LCSW (Montana) | Primary |
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