Provider Demographics
NPI:1982221933
Name:BALLWEG, NICHOLAS E (APSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
Last Name:BALLWEG
Suffix:
Gender:M
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FORWARD DR.
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:608-268-6530
Mailing Address - Fax:608-709-1744
Practice Address - Street 1:815 FORWARD DR.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-268-6530
Practice Address - Fax:608-709-1744
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19314-130101YA0400X
1041C0700X
WI132396-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)