Provider Demographics
NPI:1902258593
Name:BALLARD, DEBORAH LUCILLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LUCILLE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3961
Mailing Address - Country:US
Mailing Address - Phone:907-244-0725
Mailing Address - Fax:907-345-7760
Practice Address - Street 1:14225 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3961
Practice Address - Country:US
Practice Address - Phone:907-244-0725
Practice Address - Fax:907-345-7760
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102193174400000X
AK1021744G0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1744G0900XOther Service ProvidersSpecialistGraphics Designer