MEDICARE: CODY BALLARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1588160543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY BALLARD

Provider Business Mailing Address
First Line	:	380 ARCADIA CT
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-3345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 ARCADIA CT
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-3345
Country	:	US
Telephone Number	:	707-372-0602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/30/2018

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Directions to “ CODY BALLARD ” Practice Location

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