Provider Demographics
NPI:1902021645
Name:BALADO, KRISTIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:BALADO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 DEL RIO WAY
Mailing Address - Street 2:#404
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3541
Mailing Address - Country:US
Mailing Address - Phone:321-986-9743
Mailing Address - Fax:
Practice Address - Street 1:811 DEL RIO WAY
Practice Address - Street 2:#404
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3541
Practice Address - Country:US
Practice Address - Phone:321-986-9743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist