Provider Demographics
NPI:1174839906
Name:BALLARD, JEREMY R
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:R
Last Name:BALLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HAMMOND LN STE 6
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2008
Mailing Address - Country:US
Mailing Address - Phone:518-314-1126
Mailing Address - Fax:518-324-6628
Practice Address - Street 1:79 HAMMOND LN STE 6
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2008
Practice Address - Country:US
Practice Address - Phone:518-314-1126
Practice Address - Fax:518-324-6628
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist