MEDICARE: MS. VALERIE ANN BALL

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
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist	071009476	IL

General Provider Information

NPI Number	:	1760760714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE ANN BALL

Provider Business Mailing Address
First Line	:	512 N MCCLURG CT
Second Line	:	# 2304
City	:	CHICAGO
State	:	IL
Zip	:	60611-5359
Country	:	US
Telephone Number	:	773-726-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 WEAVER PKWY STE 204
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3864
Country	:	US
Telephone Number	:	630-473-3970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	02/21/2017

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