Healthcare Provider Details

I. General information

NPI: 1265049274
Provider Name (Legal Business Name): JEANNE YVETTE BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SOUTH ST SE
WARREN OH
44484-2445
US

IV. Provider business mailing address

2359 KNOLLWOOD AVE
YOUNGSTOWN OH
44514-1525
US

V. Phone/Fax

Practice location:
  • Phone: 216-260-1405
  • Fax: 330-632-8823
Mailing address:
  • Phone: 216-260-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: