Provider Demographics
NPI:1942488069
Name:BALLARD, KEVIN SEAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SEAN
Last Name:BALLARD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4012
Mailing Address - Country:US
Mailing Address - Phone:217-223-0204
Mailing Address - Fax:217-223-0274
Practice Address - Street 1:731 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4012
Practice Address - Country:US
Practice Address - Phone:217-223-0204
Practice Address - Fax:217-223-0274
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000916231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist