Provider Demographics
NPI:1952821399
Name:BALL, PATRICIA (AUD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MICHELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4081231H00000X
NC12423231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952821399Medicaid
NC19RGROtherBCBSNC
NCQ57640AOtherNC MEDICARE
SCSAN144Medicaid