Provider Demographics
NPI:1225578602
Name:BALL, MONTEE LOWELL
Entity Type:Individual
Prefix:
First Name:MONTEE
Middle Name:LOWELL
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GISHOLT DR STE 209
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4832
Mailing Address - Country:US
Mailing Address - Phone:608-285-9101
Mailing Address - Fax:
Practice Address - Street 1:6400 GISHOLT DR STE 209
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4832
Practice Address - Country:US
Practice Address - Phone:608-285-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician