Healthcare Provider Details

I. General information

NPI: 1215350244
Provider Name (Legal Business Name): JERI BALL LPN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 LIEB DR
NEW FRANKLIN OH
44216-9131
US

IV. Provider business mailing address

6325 LIEB DR
NEW FRANKLIN OH
44216-9131
US

V. Phone/Fax

Practice location:
  • Phone: 330-603-0793
  • Fax:
Mailing address:
  • Phone: 330-603-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-46966
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: