Provider Demographics
NPI:1700047438
Name:BALLENTINE-MUCHICKO, LAUREL ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:ANN
Last Name:BALLENTINE-MUCHICKO
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 1:1000 LOCUST STREET
Mailing Address - Street 2:AUDIOLOGY 126
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2587
Mailing Address - Country:US
Mailing Address - Phone:775-328-1854
Mailing Address - Fax:775-337-2287
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:AUDIOLOGY 126
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:775-328-1854
Practice Address - Fax:775-337-2287
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2447231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist