Individual
TANJA LEE BALLANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 MAPLE WAY, ROCK SPRINGS, WY 82901-4108
(307) 389-0784
Mailing address
1040 MAPLE WAY, ROCK SPRINGS, WY 82901-4108
(307) 389-0784
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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