Provider Demographics
NPI:1356687867
Name:BALL, KENNETH (MSW, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:MSW, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9705
Mailing Address - Country:US
Mailing Address - Phone:989-529-1228
Mailing Address - Fax:
Practice Address - Street 1:2481 BIRCH DR
Practice Address - Street 2:
Practice Address - City:KAWKAWLIN
Practice Address - State:MI
Practice Address - Zip Code:48631-9705
Practice Address - Country:US
Practice Address - Phone:895-291-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000839103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst