Provider Demographics
NPI:1497213433
Name:BALOGA, CAITLIN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BALOGA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4003
Mailing Address - Country:US
Mailing Address - Phone:570-714-1246
Mailing Address - Fax:
Practice Address - Street 1:1133 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4003
Practice Address - Country:US
Practice Address - Phone:570-714-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist