Provider Demographics
NPI:1023382355
Name:BALLARD, JOANNA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070
Mailing Address - Country:US
Mailing Address - Phone:307-256-6633
Mailing Address - Fax:303-997-1818
Practice Address - Street 1:421 S 19TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4307
Practice Address - Country:US
Practice Address - Phone:307-256-6633
Practice Address - Fax:303-997-1818
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY008176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife