Individual
MR. BERNARD J BALLEWEG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
125 BANK STREET, SUITE 310, MISSOULA, MT 59802
(406) 549-7325
(406) 549-7559
Mailing address
125 BANK STREET, SUITE 310, MISSOULA, MT 59802
(406) 549-7325
(406) 549-7559
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MT250
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492700
—
MT
01
—
53240
BCBS
MT
Enumeration date
01/24/2007
Last updated
07/08/2007
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