Provider Demographics
NPI:1013402346
Name:BALSBAUGH, CAROL LOUISE
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:BALSBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LOUISE
Other - Last Name:PASQUALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2739 ALBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3996
Mailing Address - Country:US
Mailing Address - Phone:765-455-8545
Mailing Address - Fax:
Practice Address - Street 1:2739 ALBRIGHT RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3996
Practice Address - Country:US
Practice Address - Phone:765-455-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator