Provider Demographics
NPI:1215573977
Name:BALLARD, JULIET WEBB
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:WEBB
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8174 CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9101
Mailing Address - Country:US
Mailing Address - Phone:734-972-5208
Mailing Address - Fax:734-424-1176
Practice Address - Street 1:8174 CYPRESS CIR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9101
Practice Address - Country:US
Practice Address - Phone:734-972-5208
Practice Address - Fax:734-424-1176
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker