Provider Demographics
NPI:1164055745
Name:BALUNDA, STEPHANIE ALEXIS (SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ALEXIS
Last Name:BALUNDA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 W 29TH STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-652-2477
Mailing Address - Fax:970-313-2777
Practice Address - Street 1:UCHEALTH PHYSICAL THERAPY AND REHABILITATION CLINIC
Practice Address - Street 2:6767 WEST 29TH ST.
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-652-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003408235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist