Provider Demographics
NPI:1477725661
Name:BALES, HEATHER (MA,CCC/A)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:MA,CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE C-101
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6957
Mailing Address - Country:US
Mailing Address - Phone:865-482-1086
Mailing Address - Fax:865-482-4400
Practice Address - Street 1:800 OAK RIDGE TPKE
Practice Address - Street 2:SUITE C-101
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6957
Practice Address - Country:US
Practice Address - Phone:865-482-1086
Practice Address - Fax:865-482-4400
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001315231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3192023Medicaid
TN3192023Medicare PIN