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General NPI Number Information
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NPI Number | 1538801014
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Entity Type | Individual
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Provider Name | JENNIFER L BALL
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Gender | Female
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 61690 PETTIGREW RD
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City | BEND
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State | OR
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Zip | 97702-2422
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Country | US
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Telephone | 541-617-0377
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Fax | 833-776-0563
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Provider Business Mailing Address
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Address Line | 61690 PETTIGREW RD
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City | BEND
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State | OR
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Zip | 97702-2422
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Country | US
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Telephone | 541-617-0377
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Fax | 833-776-0563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | OR
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