Healthcare Provider Details

I. General information

NPI: 1720242555
Provider Name (Legal Business Name): JAMES JOSEPH BALZA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 6TH ST
GREEN BAY WI
54304-2252
US

IV. Provider business mailing address

1160 KEPLER DR
GREEN BAY WI
54311-8321
US

V. Phone/Fax

Practice location:
  • Phone: 920-497-6161
  • Fax: 920-498-0476
Mailing address:
  • Phone: 920-288-5500
  • Fax: 920-288-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number998-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: