Provider Demographics
NPI:1790943439
Name:BALLARD, AMY NICOLE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NICOLE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 TWIN BRIDGES RD
Mailing Address - Street 2:APT 157
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2065
Mailing Address - Country:US
Mailing Address - Phone:337-794-9131
Mailing Address - Fax:
Practice Address - Street 1:2200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3611
Practice Address - Country:US
Practice Address - Phone:318-445-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist