Provider Demographics
NPI:1255810339
Name:BALIKO, STEPHANIE LEE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEE
Last Name:BALIKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 TUMBLING STONE WAY
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5973
Mailing Address - Country:US
Mailing Address - Phone:908-416-3790
Mailing Address - Fax:
Practice Address - Street 1:195 SPRINGBROOK AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8105
Practice Address - Country:US
Practice Address - Phone:919-550-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1703205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist