MEDICARE: CHARITY BALLARD CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242462	KY

General Provider Information

NPI Number	:	1366935223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY BALLARD CCC-SLP

Provider Business Mailing Address
First Line	:	140 ADAMS LN
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8761
Country	:	US
Telephone Number	:	859-200-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 SHOPPERS DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-2808
Country	:	US
Telephone Number	:	859-654-7519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	10/12/2023

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Directions to “ CHARITY BALLARD CCC-SLP” Practice Location

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