Doctor Name: | KENNETH A BALLWEG |
NPI Number: | 1174765770 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | QMHP |
License Number: | |
Business Practice Address: | 906 Main Ave Tillamook, OR - 971413816 |
Business Phone Number: | 5038428201 |
Business Fax Number: | 5038121870 |
Mailing Address: | 906 Main Ave, TILLAMOOK |
State: | OR |
Postal Code: | 971413816 |
Phone Number: | 5038428201 |
Fax Number: | 5038121870 |
NPI Enumeration Date: | 03/27/2009 |
NPI Last Update Date: | 03/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |