Provider Demographics
NPI:1023415007
Name:BALLARD-BAUMGARTEN, RITA (CHT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:BALLARD-BAUMGARTEN
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8612
Mailing Address - Country:US
Mailing Address - Phone:360-915-2910
Mailing Address - Fax:
Practice Address - Street 1:1021 S MARKET BLVD
Practice Address - Street 2:98532
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3425
Practice Address - Country:US
Practice Address - Phone:360-915-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist