Provider Demographics
NPI:1215334842
Name:BALL, GELETTA
Entity type:Individual
Prefix:MRS
First Name:GELETTA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GELETTA
Other - Middle Name:ALLEN
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, SAC-IT
Mailing Address - Street 1:2821 N 4TH ST
Mailing Address - Street 2:516
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2362
Mailing Address - Country:US
Mailing Address - Phone:414-263-6000
Mailing Address - Fax:414-263-2270
Practice Address - Street 1:2821 N 4TH ST
Practice Address - Street 2:516
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2362
Practice Address - Country:US
Practice Address - Phone:414-263-6000
Practice Address - Fax:414-263-2270
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16684-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)