Healthcare Provider Details

I. General information

NPI: 1326984923
Provider Name (Legal Business Name): AVA IRENE BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 DIX TOLEDO RD
SOUTHGATE MI
48195-2434
US

IV. Provider business mailing address

16500 QUARRY RD APT 229
SOUTHGATE MI
48195-1459
US

V. Phone/Fax

Practice location:
  • Phone: 734-224-2554
  • Fax:
Mailing address:
  • Phone: 734-224-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number883922152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: