Provider Demographics
NPI:1295274561
Name:BALLIET, NEVIN
Entity type:Individual
Prefix:
First Name:NEVIN
Middle Name:
Last Name:BALLIET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1629
Mailing Address - Country:US
Mailing Address - Phone:570-459-1400
Mailing Address - Fax:570-459-1400
Practice Address - Street 1:9 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1629
Practice Address - Country:US
Practice Address - Phone:570-459-1400
Practice Address - Fax:570-459-1400
Is Sole Proprietor?:No
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF30648237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist