Provider Demographics
NPI:1235148347
Name:BALLINGER, KATHRYN JEANETTE (MSW, LMSW, CAC-II)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JEANETTE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:MSW, LMSW, CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2409
Mailing Address - Country:US
Mailing Address - Phone:989-779-9449
Mailing Address - Fax:989-779-2922
Practice Address - Street 1:218 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2409
Practice Address - Country:US
Practice Address - Phone:989-779-9449
Practice Address - Fax:989-779-2922
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00728101YA0400X
MI98010842261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1705289Medicaid
MIOP24780Medicare ID - Type UnspecifiedOP MH & SA
MI1705289Medicaid