Provider Demographics
NPI:1629213244
Name:BALL, JIMMY WAYNE (MSW)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:WAYNE
Last Name:BALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MISSION ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6611
Mailing Address - Country:US
Mailing Address - Phone:506-667-8828
Mailing Address - Fax:509-667-2339
Practice Address - Street 1:610 N MISSION ST STE 202
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6611
Practice Address - Country:US
Practice Address - Phone:509-667-8828
Practice Address - Fax:509-667-2339
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000052571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical