Healthcare Provider Details

I. General information

NPI: 1932034295
Provider Name (Legal Business Name): KEVIN MATTHEW BALL-DUANE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 LOOKOUT RD STE 120
BOULDER CO
80301-3366
US

IV. Provider business mailing address

2813 W 69TH AVE
DENVER CO
80221-2379
US

V. Phone/Fax

Practice location:
  • Phone: 720-242-7533
  • Fax: 720-815-2613
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY.0007059
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: