Provider Demographics
NPI:1285108951
Name:BALLARD, RILEY (HAD)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BELLAMY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-1001
Mailing Address - Country:US
Mailing Address - Phone:518-955-7251
Mailing Address - Fax:
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-775-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355A2700X
VT063.0134031237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant