Provider Demographics
NPI:1619315777
Name:BALLARD, HARRY LYNN (HIS)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LYNN
Last Name:BALLARD
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18427-0948
Mailing Address - Country:US
Mailing Address - Phone:570-689-2712
Mailing Address - Fax:570-689-2714
Practice Address - Street 1:606 HAMILIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:PA
Practice Address - Zip Code:18427-0948
Practice Address - Country:US
Practice Address - Phone:570-689-2712
Practice Address - Fax:570-689-2714
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02002237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist