Provider Demographics
NPI:1275664138
Name:BALCH, ABBY SUZANNE (CCCSLP)
Entity type:Individual
Prefix:MS
First Name:ABBY
Middle Name:SUZANNE
Last Name:BALCH
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821
Mailing Address - Country:US
Mailing Address - Phone:423-623-1689
Mailing Address - Fax:
Practice Address - Street 1:5250 ANDREW JOHNSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-318-7800
Practice Address - Fax:423-318-3332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4135942OtherBCBS PROVIDER NUMBER
TN5440982Medicaid