Provider Demographics
NPI:1477886430
Name:BALLARD, EDITH JOELLEN
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:JOELLEN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 VISTA LAGUNA TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1026
Mailing Address - Country:US
Mailing Address - Phone:626-488-4748
Mailing Address - Fax:
Practice Address - Street 1:2046 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3424
Practice Address - Country:US
Practice Address - Phone:626-488-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker