Provider Demographics
NPI:1790962272
Name:BALCIAR, SHERYL ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ANN
Last Name:BALCIAR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6883 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-8430
Mailing Address - Country:US
Mailing Address - Phone:715-965-1885
Mailing Address - Fax:
Practice Address - Street 1:W6883 MAPLEWOOD LN
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-8430
Practice Address - Country:US
Practice Address - Phone:715-965-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2689-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42570200Medicaid