Provider Demographics
NPI:1154591949
Name:AMY N. BALFOUR, SPEECH-LANGUAGE PATHOLOGIST, PLLC
Entity type:Organization
Organization Name:AMY N. BALFOUR, SPEECH-LANGUAGE PATHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BALFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:919-285-3006
Mailing Address - Street 1:1692 MAIZEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7593
Mailing Address - Country:US
Mailing Address - Phone:919-285-3006
Mailing Address - Fax:919-285-3006
Practice Address - Street 1:1692 MAIZEFIELD LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7593
Practice Address - Country:US
Practice Address - Phone:919-285-3006
Practice Address - Fax:919-285-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty