Provider Demographics
NPI:1063888485
Name:BALICK, CARRIE (MS CCC - SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BALICK
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 1:2043 EAST ST # 685
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2126
Mailing Address - Country:US
Mailing Address - Phone:925-586-2994
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY
Practice Address - Street 2:STE 700
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4375
Practice Address - Country:US
Practice Address - Phone:925-586-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15418235Z00000X
CA12093494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist