Provider Demographics
NPI:1194770057
Name:BALZER, DANA L (MA, CCC-SLP L)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:L
Last Name:BALZER
Suffix:
Gender:F
Credentials:MA, CCC-SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10147 STANCIL LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8775
Mailing Address - Country:US
Mailing Address - Phone:630-302-3674
Mailing Address - Fax:
Practice Address - Street 1:10147 STANCIL LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8775
Practice Address - Country:US
Practice Address - Phone:630-302-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
IL146007434235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist