Provider Demographics
NPI:1124221189
Name:BALLARD, REBECCA J (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:BALLARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15241 JOSH WILSON
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-9676
Mailing Address - Country:US
Mailing Address - Phone:360-757-3322
Mailing Address - Fax:
Practice Address - Street 1:927 E FAIRHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1918
Practice Address - Country:US
Practice Address - Phone:360-757-3311
Practice Address - Fax:360-757-9709
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist