Provider Demographics
NPI:1548430234
Name:BALE, DEIDRE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:BALE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6800
Mailing Address - Country:US
Mailing Address - Phone:701-446-3600
Mailing Address - Fax:
Practice Address - Street 1:415 NORTH 4TH STREET
Practice Address - Street 2:FARGO SCHOOL DISTRICT #1
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4514
Practice Address - Country:US
Practice Address - Phone:701-446-1034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist