Provider Demographics
NPI:1366755597
Name:BALLARD, KRISTIN L (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:BALLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 W 65TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1700
Mailing Address - Country:US
Mailing Address - Phone:612-239-8166
Mailing Address - Fax:
Practice Address - Street 1:4005 W 65TH ST STE 110
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1700
Practice Address - Country:US
Practice Address - Phone:612-239-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent