Provider Demographics
NPI:1396874624
Name:BALLAK, CHRISTOPHER MICHAEL (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BALLAK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S CLAY ST
Mailing Address - Street 2:SUITE 202W
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3257
Mailing Address - Country:US
Mailing Address - Phone:630-248-4523
Mailing Address - Fax:
Practice Address - Street 1:40 S CLAY ST
Practice Address - Street 2:SUITE 202W
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3257
Practice Address - Country:US
Practice Address - Phone:630-248-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002228102OtherBCBS OF IL
IL206150Medicare ID - Type UnspecifiedMEDICARE
IL708850Medicare ID - Type UnspecifiedMEDICARE
IL0002228102OtherBCBS OF IL