Individual
DAWN BALLEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
315 N COLLEGE AVE, TAHLEQUAH, OK 74464-2703
(918) 453-1171
Mailing address
19216 W PETTIT BAY RD, PARK HILL, OK 74451-3010
(918) 453-1171
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4951
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200606480 A
—
OK
Enumeration date
11/12/2015
Last updated
11/12/2015
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