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Organization
JEAN D BALLOU PC
Active
Organization
JEAN D BALLOU PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN D BALLOU LCSW (OWNER)
(406) 543-9566
Entity
Organization
Contact information
Practice address
210 N HIGGINS AVE STE 314, MISSOULA, MT 59802-4443
(406) 543-9566
Mailing address
210 N HIGGINS AVE STE 314, MISSOULA, MT 59802-4443
(406) 543-9566
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
27LCSW
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000071350
BLUE CROSS BLUE SHIELD
MT
05
—
0503295
—
MT
Enumeration date
01/23/2012
Last updated
07/02/2015
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