1558546804 NPI number — MS. SUSAN LYNN BALLOW CLINICAL SOCIAL WORK

Table of content: MS. SUSAN LYNN BALLOW CLINICAL SOCIAL WORK (NPI 1558546804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558546804 NPI number — MS. SUSAN LYNN BALLOW CLINICAL SOCIAL WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLOW
Provider First Name:
SUSAN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL SOCIAL WORK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558546804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1651 MAHAN CENTER BLVD
Provider Second Line Business Mailing Address:
DEPARTMENT OF VETERANS AFFAIRS
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-324-8387
Provider Business Mailing Address Fax Number:
850-521-5702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 MAHAN CENTER BLVD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-324-8387
Provider Business Practice Location Address Fax Number:
850-521-5702
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ISW 5021 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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