Provider Demographics
NPI:1508071085
Name:BALENTINE, MARY JO (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:BALENTINE
Suffix:
Gender:F
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E.RED RIVER ST.
Mailing Address - Street 2:E2
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5531
Mailing Address - Country:US
Mailing Address - Phone:361-578-4676
Mailing Address - Fax:
Practice Address - Street 1:1501 E RED RIVER ST
Practice Address - Street 2:E2
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5522
Practice Address - Country:US
Practice Address - Phone:361-578-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50349237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist