Provider Demographics
NPI:1992136477
Name:BALLARD, JANELLE GALE (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:GALE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MS
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:4106 WILDER RD #236
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-455-2773
Mailing Address - Fax:
Practice Address - Street 1:4106 WILDER RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-455-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI06783225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist