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Individual

JEAN D BALLOU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
210 N HIGGINS AVE STE 314, MISSOULA, MT 59802-4443
(406) 543-9566
Mailing address
210 N HIGGINS AVE STE 314, MISSOULA, MT 59802-4443
(406) 543-9566

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
27LCSW
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0503295
MT
Enumeration date
12/13/2006
Last updated
07/08/2007
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