Provider Demographics
NPI:1215374442
Name:BALL, TIMOTHY GRANT (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:GRANT
Last Name:BALL
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CLOVER WAY
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8412
Mailing Address - Country:US
Mailing Address - Phone:606-776-2718
Mailing Address - Fax:
Practice Address - Street 1:209 CLOVER WAY
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8412
Practice Address - Country:US
Practice Address - Phone:606-776-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist