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NPI Code Detail

MEDICARE: MRS. CHERYL JUNE BALLEW BS

MEDICARE: MRS. CHERYL JUNE BALLEW BS
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1841204948
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHERYL JUNE BALLEW BS
Provider Business Mailing Address
First Line : 1430 OLIVE ST
Second Line : SUITE 400
City : SAINT LOUIS
State : MO
Zip : 63103-2303
Country : US
Telephone Number : 573-756-5353
Fax Number : 573-756-4557
Provider Business Practice Location Address
First Line : 1085 MAPLE ST
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-1955
Country : US
Telephone Number : 573-756-5353
Fax Number : 573-756-4557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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