Provider Demographics
NPI:1942589015
Name:BALFOUR, MARY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BALFOUR
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 1:36 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-1200
Mailing Address - Country:US
Mailing Address - Phone:607-844-8694
Mailing Address - Fax:
Practice Address - Street 1:36 UNION STREET
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:607-844-8694
Practice Address - Fax:607-844-9449
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021218-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist