Individual ProviderJennifer Dawn BallardMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address2230 Professional Dr Ste A, Santa Rosa, CA 95403-3015(707) 483-9061PECOS EnrollmentBased on the most recent information from CMS, provider Jennifer Dawn Ballard does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1831347459Provider TypeIndividualFull NameBallard, Jennifer DawnCredentialMFTGenderFemaleSole ProprietorYesEnumeration Date9/8/2008Last Updated10/26/2022Contact InformationPractice LocationPractice Address2230 Professional Dr Ste A, Santa Rosa, CA 95403-3015Phone(707) 483-9061FaxUnlisted FaxMailing LocationMailing Address2230 Professional Dr Ste A, Santa Rosa, CA 95403-3015Phone(707) 483-9061FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense50845California