Individual
JILL BALLANTYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6270 EVAN CIR, CRESTVIEW, FL 32536-4398
(608) 387-5693
Mailing address
6270 EVAN CIR, CRESTVIEW, FL 32536-4398
(608) 387-5693
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/04/2021
Last updated
08/22/2022
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