Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1053809616 |
---|---|
Provider Name | Jessica Ballard |
First Address | Missoula, MT 59802-5485 |
Second Address | Missoula, MT 59802-5485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2018 |
Last Update Date | 28/04/2018 |