NPIMap

Organization Active NPI

Jean D Ballou PC

  • Clinical Social Worker
  • Missoula, MT
National Provider Identifier
1578834586
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27LCSW Issued in MT
Legal business name
JEAN D BALLOU PC
Practice address
210 N Higgins Ave Ste 314
Missoula, MT 59802-4443
Phone
(406) 543-9566
NPI assigned
Jan 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jean D Ballou, LCSW
Title
Owner
Phone
(406) 543-9566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 27LCSW MT Primary

Addresses

Primary practice location

210 N Higgins Ave Ste 314
Missoula, MT 59802-4443

Mailing address

210 N Higgins Ave Ste 314
Missoula, MT 59802-4443
Phone (406) 543-9566

Other identifiers 2

IdentifierTypeStateIssuer
0503295MedicaidMT
0000071350OtherMTBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435795200000",
    "number": "1578834586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 N HIGGINS AVE STE 314",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024443",
            "telephone_number": "406-543-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N HIGGINS AVE STE 314",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024443",
            "telephone_number": "406-543-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEAN D BALLOU PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-23",
        "last_updated": "2015-07-02",
        "status": "A",
        "authorized_official_last_name": "BALLOU",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-543-9566",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "27LCSW",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0503295",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0000071350",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.