Healthcare Provider Details

I. General information

NPI: 1598863474
Provider Name (Legal Business Name): MS. CARRIE A BALZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 SOLUTIONS CTR
CHICAGO IL
60677-1008
US

IV. Provider business mailing address

2825 BURNET AVE
CINCINNATI OH
45219-2426
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-0527
  • Fax: 513-221-1703
Mailing address:
  • Phone: 513-221-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI 1321
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.2010180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: