Healthcare Provider Details

I. General information

NPI: 1760833099
Provider Name (Legal Business Name): MS. SAMANTHA J BALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JUNCTION RD STE 6500
MADISON WI
53717-2153
US

IV. Provider business mailing address

525 JUNCTION RD STE 6500
MADISON WI
53717-2153
US

V. Phone/Fax

Practice location:
  • Phone: 608-295-0109
  • Fax:
Mailing address:
  • Phone: 608-295-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8812-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: