Provider Demographics
NPI:1134299886
Name:BALL, JOHN ANDREW (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:BALL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W CLAIREMONT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4566
Mailing Address - Country:US
Mailing Address - Phone:715-834-2046
Mailing Address - Fax:715-834-7563
Practice Address - Street 1:2231 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5137
Practice Address - Country:US
Practice Address - Phone:715-394-4173
Practice Address - Fax:715-394-9182
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1595-1231041C0700X
WI151-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39198900Medicaid