Provider Demographics
NPI:1396500898
Name:BALLARD, KRISTINA JOY (LADC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JOY
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2404
Mailing Address - Country:US
Mailing Address - Phone:651-983-4146
Mailing Address - Fax:
Practice Address - Street 1:1715 TOWER DR W STE 100
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7609
Practice Address - Country:US
Practice Address - Phone:651-390-5001
Practice Address - Fax:651-390-5002
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306443101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)