Basic Information
| Provider Information | |||||||||
| NPI: | 1558546804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLOW | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CLINICAL SOCIAL WORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1651 MAHAN CENTER BLVD | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003248387 | ||||||||
| FaxNumber: | 8505215702 | ||||||||
| Practice Location | |||||||||
| Address1: | 1651 MAHAN CENTER BLVD | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003248387 | ||||||||
| FaxNumber: | 8505215702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ISW 5021 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.