Provider Demographics
NPI:1598911042
Name:SWEENEY, BALLAD (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BALLAD
Middle Name:
Last Name:SWEENEY
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 1:4195 N VIKING WAY STE 170
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1488
Mailing Address - Country:US
Mailing Address - Phone:562-496-3602
Mailing Address - Fax:562-206-0803
Practice Address - Street 1:4195 N VIKING WAY STE 170
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1488
Practice Address - Country:US
Practice Address - Phone:562-496-3602
Practice Address - Fax:562-206-0803
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 9073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist