Provider Demographics
NPI:1356850846
Name:BALL, JODIE OLGA (LCSW, LAC)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:OLGA
Last Name:BALL
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:MS
Other - First Name:JODIE
Other - Middle Name:OLGA
Other - Last Name:HIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LAC
Mailing Address - Street 1:4115 BOARDWALK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT. COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-493-4580
Mailing Address - Fax:970-797-2859
Practice Address - Street 1:4115 BOARDWALK DRIVE
Practice Address - Street 2:
Practice Address - City:FT. COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-493-4580
Practice Address - Fax:970-797-2859
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009921707104100000X
COLSW.099262501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000154372Medicaid