1689724429 NPI number — VELVET CHRISTINE BALMER M.S. CCC SLP

Table of content: VELVET CHRISTINE BALMER M.S. CCC SLP (NPI 1689724429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689724429 NPI number — VELVET CHRISTINE BALMER M.S. CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALMER
Provider First Name:
VELVET
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HURST
Provider Other First Name:
VELVET
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689724429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYMOND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62560-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-229-4263
Provider Business Mailing Address Fax Number:
217-229-4263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 S. MCELROY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYMOND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62560-0094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-229-4263
Provider Business Practice Location Address Fax Number:
217-229-4263
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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