Provider Demographics
NPI:1730637208
Name:BALLARD, HOLLY
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 HARTFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2150
Mailing Address - Country:US
Mailing Address - Phone:860-774-5195
Mailing Address - Fax:860-779-3628
Practice Address - Street 1:553 HARTFORD PIKE
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241
Practice Address - Country:US
Practice Address - Phone:860-774-5195
Practice Address - Fax:860-779-3628
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA330237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist