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NPI Code Detail

MEDICARE: KIMBERLY ANN BALANSAY SLP

MEDICARE: KIMBERLY ANN BALANSAY 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
1235Z00000XSpeech-Language PathologistLL60966789WA

General Provider Information

NPI Number : 1801438825
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANN BALANSAY SLP
Provider Business Mailing Address
First Line : 402 91ST AVE NE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-2530
Country : US
Telephone Number : 425-404-3107
Fax Number : 425-335-1894
Provider Business Practice Location Address
First Line : 402 91ST AVE NE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-2530
Country : US
Telephone Number : 425-404-3107
Fax Number : 425-335-1894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2019
Last Update Date : 11/10/2021

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Directions to “ KIMBERLY ANN BALANSAY SLP” Practice Location

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