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General NPI Number Information
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NPI Number | 1598279903
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Entity Type | Individual
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Provider Name | LESLEY-ANN BALLINGER M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 1200 HAWTHORN HOUSE DR
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City | SHALIMAR
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State | FL
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Zip | 32579-1168
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Country | US
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Telephone | 850-609-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 515 BOULDER ST
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City | CRESTVIEW
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State | FL
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Zip | 32536-2251
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Country | US
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Telephone | 913-669-9315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA15835
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14182258
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License Number State |
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