# JEAN D BALLOU PC

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

## Provider details

- **NPI number:** 1578834586
- **Authorized official:** JEAN D BALLOU LCSW (OWNER)
- **Authorized official phone:** (406) 543-9566

## Contact information

- **Practice address:** 210 N HIGGINS AVE STE 314, MISSOULA, MT 59802-4443
- **Practice address phone:** (406) 543-9566
- **Mailing address:** 210 N HIGGINS AVE STE 314, MISSOULA, MT 59802-4443
- **Mailing address phone:** (406) 543-9566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 27LCSW | MT | Yes |

## Other

- **Enumeration date:** 01/23/2012
- **Last updated:** 07/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000071350 | BLUE CROSS BLUE SHIELD | MT |
| 05 | — | 0503295 | — | MT |