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Individual

LOGAN MICHAEL BALLARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2355 W LEMARCHE AVE, PHOENIX, AZ 85023-4122
(602) 688-6925
(602) 296-0414
Mailing address
14191 W CALAVAR RD, SURPRISE, AZ 85379-8623
(623) 755-7360

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-357282
AZ

Other

Enumeration date
07/10/2024
Last updated
07/10/2024
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