Healthcare Provider Details

I. General information

NPI: 1982430591
Provider Name (Legal Business Name): NICOLE MARIE BALASSONE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 15-200
CHICAGO IL
60611-5967
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 15-200
CHICAGO IL
60611-5967
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8182
  • Fax: 312-695-4303
Mailing address:
  • Phone: 312-695-8182
  • Fax: 312-695-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147002021
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: