Provider Demographics
NPI:1679156715
Name:BALLARD, KARIN (MS RDN)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2201
Mailing Address - Country:US
Mailing Address - Phone:773-343-6810
Mailing Address - Fax:
Practice Address - Street 1:301 S BLOUNT ST STE 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4664
Practice Address - Country:US
Practice Address - Phone:608-405-5111
Practice Address - Fax:608-554-1052
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3641-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered