Provider Demographics
NPI:1740451368
Name:BALLARD, KATHLENE R (MSW)
Entity type:Individual
Prefix:
First Name:KATHLENE
Middle Name:R
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PATHWAYS
Mailing Address - Street 2:200 SPRING ST.
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-387-3611
Mailing Address - Fax:906-387-4212
Practice Address - Street 1:PATHWAYS
Practice Address - Street 2:200 SPRING ST.
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-387-3611
Practice Address - Fax:906-387-4212
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010592631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical