Provider Demographics
NPI:1316339435
Name:BALOG SPEECH & LANGUAGE CENTER, PLLC
Entity type:Organization
Organization Name:BALOG SPEECH & LANGUAGE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-658-6150
Mailing Address - Street 1:1060 CHERRY
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2153
Mailing Address - Country:US
Mailing Address - Phone:734-658-6150
Mailing Address - Fax:
Practice Address - Street 1:1060 CHERRY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2153
Practice Address - Country:US
Practice Address - Phone:734-658-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty