Provider Demographics
NPI:1558546804
Name:BALLOW, SUSAN LYNN (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:BALLOW
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
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Mailing Address - Street 1:1651 MAHAN CENTER BLVD
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:800-324-8387
Mailing Address - Fax:850-521-5702
Practice Address - Street 1:1651 MAHAN CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:800-324-8387
Practice Address - Fax:850-521-5702
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 50211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical