Provider Demographics
NPI:1003499484
Name:BALLARD, RHEAGAN DIANE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RHEAGAN
Middle Name:DIANE
Last Name:BALLARD
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:ACHILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74720-0280
Mailing Address - Country:US
Mailing Address - Phone:580-283-3775
Mailing Address - Fax:
Practice Address - Street 1:201 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:ACHILLE
Practice Address - State:OK
Practice Address - Zip Code:74720-0280
Practice Address - Country:US
Practice Address - Phone:580-283-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist