Provider Demographics
NPI:1922435189
Name:BALLINGER, SUSAN (MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 MILAN TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6711
Mailing Address - Country:US
Mailing Address - Phone:970-402-3259
Mailing Address - Fax:
Practice Address - Street 1:821 DUFFIELD CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5228
Practice Address - Country:US
Practice Address - Phone:970-669-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP 0000933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist