| Specialty | Taxonomy Code | |
|---|---|---|
| * | Student Health | 261QS1000X |
| Dental | 261QD0000X |
* Indicates primary specialty
| NPI Number | 1861938177 |
| Legal business name LBN |
CNMC CLINIC AT BALLOU HS |
| Authorized official | SUSAN PFENNIG - (SENIOR MANAGER) |
| Entity | Organization |
| Organization subpart | Yes |
| Enumeration date | 01/10/2017 |
| Last updated | 12/18/2017 - About 8 years ago |
| Sole proprietor1 | Not specified |
| Identifiers | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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