Provider Demographics
NPI:1275816647
Name:BALL, COLLEEN RENEE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:RENEE
Last Name:BALL
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 UNION ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3919
Mailing Address - Country:US
Mailing Address - Phone:740-349-7066
Mailing Address - Fax:740-345-6028
Practice Address - Street 1:195 UNION ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3919
Practice Address - Country:US
Practice Address - Phone:740-349-7066
Practice Address - Fax:740-345-6028
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13028481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical