Provider Demographics
NPI:1013614551
Name:BALL, KEEGHAN PATRICK-WAYNE
Entity type:Individual
Prefix:
First Name:KEEGHAN
Middle Name:PATRICK-WAYNE
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 E BELTLINE AVE NE STE 310
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9350
Mailing Address - Country:US
Mailing Address - Phone:616-279-6414
Mailing Address - Fax:616-591-3393
Practice Address - Street 1:4829 E BELTLINE AVE NE STE 310
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9350
Practice Address - Country:US
Practice Address - Phone:616-279-6414
Practice Address - Fax:616-591-3393
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst