Provider Demographics
NPI:1205105350
Name:BALL, ANN TONETTE (LMFT, CSAC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:TONETTE
Last Name:BALL
Suffix:
Gender:F
Credentials:LMFT, CSAC
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:TONETTE
Other - Last Name:REALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, CSAC
Mailing Address - Street 1:2004 HIGHLAND AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4400
Mailing Address - Country:US
Mailing Address - Phone:715-835-5915
Mailing Address - Fax:715-835-8112
Practice Address - Street 1:2004 HIGHLAND AVE
Practice Address - Street 2:SUITE N
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4400
Practice Address - Country:US
Practice Address - Phone:715-835-5915
Practice Address - Fax:715-835-8112
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11439-132101YA0400X
WI680-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)