Provider Demographics
NPI:1508009721
Name:BALENT, JERILYN H, (AUD)
Entity Type:Individual
Prefix:DR
First Name:JERILYN
Middle Name:H,
Last Name:BALENT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 TOWNSHIP LINE RD.
Mailing Address - Street 2:
Mailing Address - City:WYCOMBE
Mailing Address - State:PA
Mailing Address - Zip Code:18980
Mailing Address - Country:US
Mailing Address - Phone:267-994-6763
Mailing Address - Fax:215-359-1664
Practice Address - Street 1:4148 TOWNSHIP LINE RD.
Practice Address - Street 2:
Practice Address - City:WYCOMBE
Practice Address - State:PA
Practice Address - Zip Code:18980
Practice Address - Country:US
Practice Address - Phone:267-994-6763
Practice Address - Fax:215-359-1664
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT-000074-L231H00000X
NJYA 00181231H00000X
NJMG 00585237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter