Provider Demographics
NPI:1215090246
Name:BALLI, GINA (MSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BALLI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:BALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:4033 E MADISON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3104
Mailing Address - Country:US
Mailing Address - Phone:206-322-2222
Mailing Address - Fax:
Practice Address - Street 1:4033 E MADISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3104
Practice Address - Country:US
Practice Address - Phone:206-322-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000061141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical