Individual
DESTINY BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
606 E BALTIMORE PIKE FL 2, MEDIA, PA 19063-1751
(610) 864-7376
(877) 599-3340
Mailing address
5 REVERE DR STE 120, NORTHBROOK, IL 60062-8005
(800) 356-4049
(941) 485-0519
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-135056
PA
Other
Enumeration date
11/25/2020
Last updated
11/25/2020
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