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NPI Code Detail

MEDICARE: LISA ANN BALLIEN LBSW

MEDICARE: LISA ANN BALLIEN LBSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6802068558MI

General Provider Information

NPI Number : 1275899551
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ANN BALLIEN LBSW
Provider Business Mailing Address
First Line : 35425 W MICHIGAN AVE
Second Line :
City : WAYNE
State : MI
Zip : 48184-9800
Country : US
Telephone Number : 248-794-0372
Fax Number : 248-547-3052
Provider Business Practice Location Address
First Line : 35425 W MICHIGAN AVE
Second Line :
City : WAYNE
State : MI
Zip : 48184-9800
Country : US
Telephone Number : 248-794-0372
Fax Number : 248-547-3052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2012
Last Update Date : 02/21/2024

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Directions to “ LISA ANN BALLIEN LBSW” Practice Location

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