Individual
OLIVIA SHAE BALLAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.B.T
Contact information
Practice address
1155 KELLY JOHNSON BLVD STE 150, COLORADO SPRINGS, CO 80920-3931
(719) 354-2582
(720) 493-4632
Mailing address
8289 FORT SMITH RD, FALCON, CO 80831-7937
(719) 243-7866
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-16-13105
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R410449
—
CO
Enumeration date
05/07/2016
Last updated
05/07/2016
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