Provider Demographics
NPI:1285986299
Name:BALL, NICOLE YVETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:YVETTE
Last Name:BALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:YVETTE
Other - Last Name:YELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6799 SW WILSONVILLE RD
Mailing Address - Street 2:APT. 239
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5825
Mailing Address - Country:US
Mailing Address - Phone:315-719-8735
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-947-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2202103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical