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NPI Code Detail

MEDICARE: SUSAN BALLAD

MEDICARE: SUSAN BALLAD
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1841737111
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN BALLAD
Provider Business Mailing Address
First Line : 3315 SPRING MOUNTAIN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-8603
Country : US
Telephone Number : 702-754-3484
Fax Number :
Provider Business Practice Location Address
First Line : 3315 SPRING MOUNTAIN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-8603
Country : US
Telephone Number : 702-754-3484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2017
Last Update Date : 01/25/2017

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Directions to “ SUSAN BALLAD ” Practice Location

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