Provider Demographics
NPI:1710299870
Name:BALCERAK, GENEVIEVE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:ELIZABETH
Last Name:BALCERAK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GENEVIEVE
Other - Middle Name:ELIZABETH
Other - Last Name:FOLLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3123 EUGENE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7281
Mailing Address - Country:US
Mailing Address - Phone:630-820-6591
Mailing Address - Fax:
Practice Address - Street 1:3123 EUGENE LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7281
Practice Address - Country:US
Practice Address - Phone:630-820-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB42628578699222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist