Provider Demographics
NPI:1013208040
Name:BALLAS, MARION (MSDE)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:BALLAS
Suffix:
Gender:F
Credentials:MSDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HARRIGAN CT
Mailing Address - Street 2:APT 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6386
Mailing Address - Country:US
Mailing Address - Phone:781-929-0906
Mailing Address - Fax:
Practice Address - Street 1:146 HARRIGAN CT
Practice Address - Street 2:APT 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6386
Practice Address - Country:US
Practice Address - Phone:781-929-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist